Active NPI
Michael Civitello
- Behavior Technician
- Uncasville, CT
National Provider Identifier
1407540495
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- Practice address
- 912 Norwich New London Tpke Ste 5
Uncasville, CT 06382-1908 - Phone
- (860) 848-0514
- Fax
- (860) 848-0523
- NPI assigned
- Jun 5, 2023
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | Primary |
Addresses
Primary practice location
912 Norwich New London Tpke Ste 5
Uncasville, CT 06382-1908
Mailing address
912 Norwich New London Tpke Ste 5
Uncasville, CT 06382-1908
Phone (860) 848-0514
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Creative Potential LLC | Current | Accepting new patients | |
| Creative Potential LLC | Current | Accepting new patients |
Locations
912 Norwich New London Tpke
Ste 5
Uncasville, CT 06382
Phone (860) 848-0514
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Personal Care Attendant
- Uncasville, CT
- NPI 1114504941
-
- Counselor
- Uncasville, CT
- NPI 1679239826
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1685923200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1685923200000",
"number": "1407540495",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "912 NORWICH NEW LONDON TPKE STE 5",
"city": "UNCASVILLE",
"state": "CT",
"postal_code": "063821908",
"telephone_number": "860-848-0514",
"fax_number": "860-848-0523"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "912 NORWICH NEW LONDON TPKE STE 5",
"city": "UNCASVILLE",
"state": "CT",
"postal_code": "063821908",
"telephone_number": "860-848-0514",
"fax_number": "860-848-0523"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CIVITELLO",
"first_name": "MICHAEL",
"name_prefix": "Mr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-06-05",
"last_updated": "2023-06-05",
"certification_date": "2023-06-05",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Uncasville, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.