Provider Demographics
NPI:1033772108
Name:VIVEROS, CELIA ELIZABETH (LICSW)
Entity Type:Individual
Prefix:
First Name:CELIA
Middle Name:ELIZABETH
Last Name:VIVEROS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11611 26TH AVE S
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98168-1209
Mailing Address - Country:US
Mailing Address - Phone:509-521-6876
Mailing Address - Fax:
Practice Address - Street 1:11611 26TH AVE S
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98168-1209
Practice Address - Country:US
Practice Address - Phone:509-521-6876
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-15
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC194651041C0700X
WALW604778301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty