Kimberly Lacivita, PSY.D. P.A.

Primary specialty

School PsychologistTaxonomy code 103TS0200X

License

SS1610 Issued in FL

Practice address

7345 International PL Ste 109
Lakewood Ranch, FL 34240-8468

Phone

(941) 702-9978

Fax

(941) 203-4822

NPI assigned

Jan 8, 2024

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Physician Assistant

State licenses

Practice roles

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.

• Family Center of Psychotherapy/Psychiatry & Evaluation

  • Clinical Psychologist
  • Lakewood Ranch, FL
  • NPI 1659752640
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1704672000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1704672000000",
    "number": "1952171241",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2073 SANDRALA DR",
            "city": "SARASOTA",
            "state": "FL",
            "postal_code": "342313425"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7345 INTERNATIONAL PL STE 109",
            "city": "LAKEWOOD RANCH",
            "state": "FL",
            "postal_code": "342408468",
            "telephone_number": "941-702-9978",
            "fax_number": "941-203-4822"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LACIVITA",
        "first_name": "KIMBERLY",
        "name_prefix": "Dr.",
        "credential": "PSY.D. P.A.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-01-08",
        "last_updated": "2024-01-08",
        "certification_date": "2024-01-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TS0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, School",
            "state": "FL",
            "license": "SS1610",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Vivek V Kumar, D.O.
• Danielle Labonte
• Amy Elizabeth Labrie, BCBA
• Amy Lynne Labron, APRN
• Michael A Labun Sr.
• Gillian Anna Laco, DPT
• Peter Lacroce, PHARM.D.
• Heather Lacy, PA
• Emmy Caroline Ladehoff
• Jeffrey Shane Ladwig, APRN

• School Psychologist in Lakewood Ranch, FL
• Providers in Lakewood Ranch, FL by specialty
• School Psychologist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.