Provider Demographics
NPI:1235306069
Name:BADER, VIVIAN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:VIVIAN
Middle Name:
Last Name:BADER
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 1:120 W 70TH ST
Mailing Address - Street 2:6-D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-4417
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:65 CENTRAL PARK W
Practice Address - Street 2:1-D
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-6007
Practice Address - Country:US
Practice Address - Phone:212-229-8009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-12
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR031348-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health