Provider Demographics
NPI:1316588874
Name:VETHENCOURT ROMERO, VIVIANA C (LPC)
Entity Type:Individual
Prefix:
First Name:VIVIANA
Middle Name:C
Last Name:VETHENCOURT ROMERO
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1345 IVY ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80220-2643
Mailing Address - Country:US
Mailing Address - Phone:954-534-6744
Mailing Address - Fax:
Practice Address - Street 1:1345 IVY ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80220-2643
Practice Address - Country:US
Practice Address - Phone:954-534-6744
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-04
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH17410101YM0800X
CO0020736101YP2500X
CO0019387101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health