MEDICARE: DR. JESSICA D. CIAVARELLA PSY.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	103TC0700X	Clinical Psychologist	PY 7107	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	12378663	OTHER	FL	MULTIPLAN
2	161720383	OTHER	FL	HORIZON HEALTH
3	7670760	OTHER	FL	AETNA
4	75064	OTHER	FL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1528090354
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JESSICA D. CIAVARELLA PSY.D.

Provider Business Mailing Address
First Line	:	9000 SHERIDAN ST
Second Line	:	SUITE 121
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33024-8802
Country	:	US
Telephone Number	:	954-552-7510
Fax Number	:	954-212-6100

Provider Business Practice Location Address
First Line	:	9000 SHERIDAN ST
Second Line	:	SUITE 121
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33024-8802
Country	:	US
Telephone Number	:	954-552-7510
Fax Number	:	954-212-6100

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

Provider Enumeration Date	:	07/06/2006
Last Update Date	:	10/22/2013

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