Provider Demographics
NPI:1053657833
Name:VIVIAN, JOY ANN (LICSW)
Entity Type:Individual
Prefix:MS
First Name:JOY
Middle Name:ANN
Last Name:VIVIAN
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 1:107 PAUL AVE N
Mailing Address - Street 2:
Mailing Address - City:COLOGNE
Mailing Address - State:MN
Mailing Address - Zip Code:55322-9330
Mailing Address - Country:US
Mailing Address - Phone:952-361-9700
Mailing Address - Fax:
Practice Address - Street 1:107 PAUL AVE N
Practice Address - Street 2:
Practice Address - City:COLOGNE
Practice Address - State:MN
Practice Address - Zip Code:55322-9330
Practice Address - Country:US
Practice Address - Phone:952-361-9700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-23
Last Update Date:2012-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN024251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical