Provider Demographics
NPI:1467497214
Name:VIVERO, MARGO LYNN (LPC)
Entity Type:Individual
Prefix:MS
First Name:MARGO
Middle Name:LYNN
Last Name:VIVERO
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 1:237 E CENTER ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06040-5209
Mailing Address - Country:US
Mailing Address - Phone:860-533-1860
Mailing Address - Fax:860-647-1060
Practice Address - Street 1:237 E CENTER ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06040-5209
Practice Address - Country:US
Practice Address - Phone:860-533-1860
Practice Address - Fax:860-647-1060
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000788101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional