Provider Demographics
NPI:1760722235
Name:COLOSIMO-BLAIR, VIVIANA (MSW)
Entity Type:Individual
Prefix:
First Name:VIVIANA
Middle Name:
Last Name:COLOSIMO-BLAIR
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 399
Mailing Address - Street 2:
Mailing Address - City:CARNELIAN BAY
Mailing Address - State:CA
Mailing Address - Zip Code:96140-0399
Mailing Address - Country:US
Mailing Address - Phone:530-546-1956
Mailing Address - Fax:530-546-1939
Practice Address - Street 1:5225 N. LAKE BLVD
Practice Address - Street 2:
Practice Address - City:CARNELIAN BAY
Practice Address - State:CA
Practice Address - Zip Code:96140
Practice Address - Country:US
Practice Address - Phone:530-546-1956
Practice Address - Fax:530-546-1939
Is Sole Proprietor?:No
Enumeration Date:2013-02-21
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker