Provider Demographics
NPI:1740574367
Name:MIDGETTE, VIANEY (PHD)
Entity Type:Individual
Prefix:DR
First Name:VIANEY
Middle Name:
Last Name:MIDGETTE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:VIANEY
Other - Middle Name:
Other - Last Name:ACEVEDO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:1045 W REDONDO BEACH BLVD STE 150
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90247-4198
Mailing Address - Country:US
Mailing Address - Phone:310-767-1221
Mailing Address - Fax:310-767-1403
Practice Address - Street 1:1045 W REDONDO BEACH BLVD STE 150
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90247-4198
Practice Address - Country:US
Practice Address - Phone:310-767-1221
Practice Address - Fax:310-767-1403
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-31
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY24887103TC0700X, 103TC1900X, 103TP2701X, 103T00000X
103TF0000X, 103TA0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy