1417280447 NPI number — MRS. GRACE MARIE VIVALDI M.A. PSYCHOLOGY

Table of content: (NPI 1093714115)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417280447 NPI number — MRS. GRACE MARIE VIVALDI M.A. PSYCHOLOGY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VIVALDI
Provider First Name:
GRACE
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.A. PSYCHOLOGY
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
VIVALDI
Provider Other First Name:
GRACE
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.A. PSYCHOLOGY
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1417280447
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/09/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
URUGUAY ST. B-5 HAC. MONTE VERDE
Provider Second Line Business Mailing Address:
GRACE M. VIVALDI
Provider Business Mailing Address City Name:
VEGA BAJA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00693-5822
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-854-7060
Provider Business Mailing Address Fax Number:
787-854-7021

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
B5 CALLE URUGUAY
Provider Second Line Business Practice Location Address:
HACIENDAS DE MONTE VERDE
Provider Business Practice Location Address City Name:
VEGA BAJA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00693-5822
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-854-7060
Provider Business Practice Location Address Fax Number:
787-854-7021
Provider Enumeration Date:
09/09/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  781 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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