Provider Demographics
NPI:1003366741
Name:ESTEVEZ, VIVIAN SUSSELLE (LMFT)
Entity Type:Individual
Prefix:
First Name:VIVIAN
Middle Name:SUSSELLE
Last Name:ESTEVEZ
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2755 SAN BRUNO AVE UNIT 347298
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94134-1557
Mailing Address - Country:US
Mailing Address - Phone:650-898-5423
Mailing Address - Fax:650-564-9948
Practice Address - Street 1:355 GELLERT BLVD STE 280
Practice Address - Street 2:
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015-2619
Practice Address - Country:US
Practice Address - Phone:650-898-5423
Practice Address - Fax:650-564-9948
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-05
Last Update Date:2016-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34644106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist