Provider Demographics
NPI:1407124217
Name:VIVAS, KAIRO (LCSW-C)
Entity Type:Individual
Prefix:MR
First Name:KAIRO
Middle Name:
Last Name:VIVAS
Suffix:
Gender:M
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 RESERVOIR CIR STE 105
Mailing Address - Street 2:
Mailing Address - City:PIKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-6362
Mailing Address - Country:US
Mailing Address - Phone:202-250-9008
Mailing Address - Fax:
Practice Address - Street 1:8 RESERVOIR CIR STE 105
Practice Address - Street 2:
Practice Address - City:PIKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21208-6362
Practice Address - Country:US
Practice Address - Phone:202-670-3704
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-07
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD174471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical