Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XM0800X | Mental Health | 5201009829 | MI |
NPI | 1942726450 |
---|---|
Provider Name | Julie Viviano |
First Address | Hastings, MI 49058-9018 |
Second Address | Hastings, MI 49058 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2017 |
Last Update Date | 16/08/2017 |