Provider Demographics
NPI:1477376671
Name:KITTII, CIVERRA
Entity type:Individual
Prefix:
First Name:CIVERRA
Middle Name:
Last Name:KITTII
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ERES
Other - Middle Name:
Other - Last Name:MICHELLE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2921 OLD FRANKLIN RD APT 120
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:TN
Mailing Address - Zip Code:37013-3178
Mailing Address - Country:US
Mailing Address - Phone:615-290-1961
Mailing Address - Fax:
Practice Address - Street 1:5203 MARYLAND WAY STE 104
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-5022
Practice Address - Country:US
Practice Address - Phone:615-560-6622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-05
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician