Provider Demographics
NPI:1295714970
Name:CIVEROLO, GINA M (MA LPCC DAPA)
Entity type:Individual
Prefix:MRS
First Name:GINA
Middle Name:M
Last Name:CIVEROLO
Suffix:
Gender:F
Credentials:MA LPCC DAPA
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Other - First Name:
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Mailing Address - Street 1:933 BRADBURY DR SE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-4374
Mailing Address - Country:US
Mailing Address - Phone:505-272-3120
Mailing Address - Fax:505-272-8060
Practice Address - Street 1:2450 ALAMO AVE SE
Practice Address - Street 2:C/O ASAP
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-3204
Practice Address - Country:US
Practice Address - Phone:505-925-2400
Practice Address - Fax:505-925-2411
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2012-05-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NM1482174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist