Provider Demographics
NPI:1558079137
Name:GARCIA, VIVIAN VANESSA (LMSW)
Entity Type:Individual
Prefix:
First Name:VIVIAN
Middle Name:VANESSA
Last Name:GARCIA
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:VIVIAN
Other - Middle Name:VANESSA
Other - Last Name:TALAMANTES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMSW
Mailing Address - Street 1:7253 WATSON RD # 169
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63119-4401
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8045 BIG BEND BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63119-2709
Practice Address - Country:US
Practice Address - Phone:314-800-0311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-11
Last Update Date:2022-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022040046104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker