Provider Demographics
NPI:1710925508
Name:VIVINO, GENEVA (NP)
Entity Type:Individual
Prefix:
First Name:GENEVA
Middle Name:
Last Name:VIVINO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:667 STONELEIGH AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:CARMEL
Mailing Address - State:NY
Mailing Address - Zip Code:10512-2454
Mailing Address - Country:US
Mailing Address - Phone:845-279-6381
Mailing Address - Fax:845-279-5447
Practice Address - Street 1:667 STONELEIGH AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:CARMEL
Practice Address - State:NY
Practice Address - Zip Code:10512-2454
Practice Address - Country:US
Practice Address - Phone:845-279-5908
Practice Address - Fax:845-279-5447
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2009-10-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY400496363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health