Provider Demographics
NPI:1376619015
Name:GEREMIA, VIVIAN BELLA
Entity Type:Individual
Prefix:MRS
First Name:VIVIAN
Middle Name:BELLA
Last Name:GEREMIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:VIVIAN
Other - Middle Name:BELLA
Other - Last Name:JACOBS GEREMIA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:104 FOX MEADOW ROAD
Mailing Address - Street 2:
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583
Mailing Address - Country:US
Mailing Address - Phone:914-725-6473
Mailing Address - Fax:
Practice Address - Street 1:104 FOX MEADOW ROAD
Practice Address - Street 2:
Practice Address - City:SCARSDALE
Practice Address - State:NY
Practice Address - Zip Code:10583
Practice Address - Country:US
Practice Address - Phone:914-725-6473
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000642106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist