Active NPI
Angie Civilus, BA
- Behavior Technician
- Brookhaven, GA
National Provider Identifier
1740896091
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- License
- RBT-19-100161
- Practice address
- 3105 Clairmont Rd NE
Brookhaven, GA 30329-1015 - Phone
- (470) 241-1353
- Fax
- (317) 520-8200
- NPI assigned
- Sep 22, 2020
- Sex
- Female
- 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 | RBT-19-100161 | GA | Primary |
Addresses
Primary practice location
3105 Clairmont Rd NE
Brookhaven, GA 30329-1015
Mailing address
3500 Depauw Blvd Ste 3070
Indianapolis, IN 46268-6135
Phone (855) 324-0885
Other names 1
- Angie Germain
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
- Credentials
- Bachelor of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RBT-19-100161 | GA | MD | Behavior Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1600732800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1600732800000",
"number": "1740896091",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3500 DEPAUW BLVD STE 3070",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462686135",
"telephone_number": "855-324-0885",
"fax_number": "317-520-8200"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3105 CLAIRMONT RD NE",
"city": "BROOKHAVEN",
"state": "GA",
"postal_code": "303291015",
"telephone_number": "470-241-1353",
"fax_number": "317-520-8200"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CIVILUS",
"first_name": "ANGIE",
"credential": "BA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-09-22",
"last_updated": "2020-09-22",
"certification_date": "2020-09-22",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "GA",
"license": "RBT-19-100161",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "ANGIE",
"last_name": "GERMAIN",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Brookhaven, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.