Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TB0200X | Cognitive & Behavioral Psychologist |
NPI | 1083026058 |
---|---|
Provider Name | Nadine Vivarelli |
First Address | Las Vegas, NV 89146-5100 |
Second Address | Las Vegas, NV 89146-5100 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/05/2014 |
Last Update Date | 27/05/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1912294554 | (05) | NV |