Provider Demographics
NPI:1699041400
Name:VIVENZIO, CARMELINA ANN
Entity Type:Individual
Prefix:MISS
First Name:CARMELINA
Middle Name:ANN
Last Name:VIVENZIO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1905 ROUTE 52
Mailing Address - Street 2:
Mailing Address - City:WALDEN
Mailing Address - State:NY
Mailing Address - Zip Code:12586-2255
Mailing Address - Country:US
Mailing Address - Phone:845-742-5251
Mailing Address - Fax:
Practice Address - Street 1:1905 ROUTE 52
Practice Address - Street 2:
Practice Address - City:WALDEN
Practice Address - State:NY
Practice Address - Zip Code:12586-2255
Practice Address - Country:US
Practice Address - Phone:845-742-5251
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-26
Last Update Date:2012-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017183225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist