Provider Demographics
NPI:1043299670
Name:SKLAR, VIVIAN ANNETTE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:VIVIAN
Middle Name:ANNETTE
Last Name:SKLAR
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:153 MAIN STREET
Mailing Address - Street 2:SUITE G
Mailing Address - City:MOUNT KISCO
Mailing Address - State:NY
Mailing Address - Zip Code:10549
Mailing Address - Country:US
Mailing Address - Phone:914-244-3141
Mailing Address - Fax:914-244-4124
Practice Address - Street 1:153 MAIN STREET
Practice Address - Street 2:SUITE G
Practice Address - City:MOUNT KISCO
Practice Address - State:NY
Practice Address - Zip Code:10549
Practice Address - Country:US
Practice Address - Phone:914-244-3141
Practice Address - Fax:914-244-4124
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-12
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0479721104100000X
NYR0479721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN9C571Medicare UPIN