Provider Demographics
NPI:1104026632
Name:VIVIANO, TAMARA FAITH (PHD)
Entity Type:Individual
Prefix:DR
First Name:TAMARA
Middle Name:FAITH
Last Name:VIVIANO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3001 SW COLLEGE RD
Mailing Address - Street 2:PO BOX 1388
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34474-4415
Mailing Address - Country:US
Mailing Address - Phone:352-854-2322
Mailing Address - Fax:352-873-5826
Practice Address - Street 1:3001 SW COLLEGE RD
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34474-4415
Practice Address - Country:US
Practice Address - Phone:352-854-2322
Practice Address - Fax:352-873-5826
Is Sole Proprietor?:No
Enumeration Date:2007-07-23
Last Update Date:2009-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY7395103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent