Provider Demographics
NPI:1730860032
Name:CIAVARELLA, NICOLE TERESA
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:TERESA
Last Name:CIAVARELLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:523 JACKSON ST UNIT 311
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55101-2469
Mailing Address - Country:US
Mailing Address - Phone:845-826-1190
Mailing Address - Fax:
Practice Address - Street 1:4756 BANNING AVE
Practice Address - Street 2:
Practice Address - City:WHITE BEAR LAKE
Practice Address - State:MN
Practice Address - Zip Code:55110-3205
Practice Address - Country:US
Practice Address - Phone:845-826-1190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-28
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health