| Doctor Name: | MR. PATRICK WILLIAM CIVIELLO |
| NPI Number: | 1669789590 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.A., CCC-SLP |
| License Number: | SP889 |
| Business Practice Address: | 100 Main Street Sad 6 Bar Mills, ME - 040040038 |
| Business Phone Number: | 2079295955 |
| Business Fax Number: | 2079293831 |
| Mailing Address: | Po Box 38, Msad 6, 100 Main Street BAR MILLS |
| State: | ME |
| Postal Code: | 04004 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 09/14/2010 |
| NPI Last Update Date: | 09/14/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | SP889 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | ME |
| Taxonomy Type: | Speech, Language and Hearing Service Providers |
| Taxonomy Classification: | Speech-Language Pathologist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A speech pathologist is a person qualified by a master |