MEDICARE: DR. JANET SCARBOROUGH CIVITELLI PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	34252	TX

General Provider Information

NPI Number	:	1336691708
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JANET SCARBOROUGH CIVITELLI PH.D.

Provider Business Mailing Address
First Line	:	1401 LAVACA ST STE 40896
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78701-1634
Country	:	US
Telephone Number	:	512-348-8468
Fax Number	:	512-265-9722

Provider Business Practice Location Address
First Line	:	1401 LAVACA ST STE 40896
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78701-1634
Country	:	US
Telephone Number	:	512-348-8468
Fax Number	:	512-265-9722

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/01/2016
Last Update Date	:	09/16/2024

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