Provider Demographics
NPI:1417280447
Name:VIVALDI, GRACE MARIE (MA PSYCHOLOGY)
Entity Type:Individual
Prefix:MRS
First Name:GRACE
Middle Name:MARIE
Last Name:VIVALDI
Suffix:
Gender:F
Credentials:MA PSYCHOLOGY
Other - Prefix:MRS
Other - First Name:GRACE
Other - Middle Name:MARIE
Other - Last Name:VIVALDI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA PSYCHOLOGY
Mailing Address - Street 1:URUGUAY ST. B-5 HAC. MONTE VERDE
Mailing Address - Street 2:GRACE M. VIVALDI
Mailing Address - City:VEGA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00693-5822
Mailing Address - Country:US
Mailing Address - Phone:787-854-7060
Mailing Address - Fax:787-854-7021
Practice Address - Street 1:B5 CALLE URUGUAY
Practice Address - Street 2:HACIENDAS DE MONTE VERDE
Practice Address - City:VEGA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00693-5822
Practice Address - Country:US
Practice Address - Phone:787-854-7060
Practice Address - Fax:787-854-7021
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-09
Last Update Date:2009-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR781103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist