Provider Demographics
NPI:1497455042
Name:VIVA MENTAL HEALTH COUNSELING PC
Entity Type:Organization
Organization Name:VIVA MENTAL HEALTH COUNSELING PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:YESENIA
Authorized Official - Last Name:VASCONEZ
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:347-496-9566
Mailing Address - Street 1:151 N FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-4305
Mailing Address - Country:US
Mailing Address - Phone:347-496-9566
Mailing Address - Fax:
Practice Address - Street 1:151 N FOREST AVE
Practice Address - Street 2:
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-4305
Practice Address - Country:US
Practice Address - Phone:347-496-9566
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-02
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)