Provider Demographics
NPI:1821343856
Name:MISSHULA, VIVIEN (LMSW)
Entity Type:Individual
Prefix:MS
First Name:VIVIEN
Middle Name:
Last Name:MISSHULA
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 LASER CT
Mailing Address - Street 2:
Mailing Address - City:HAUPPAUGE
Mailing Address - State:NY
Mailing Address - Zip Code:11788-3958
Mailing Address - Country:US
Mailing Address - Phone:631-853-2337
Mailing Address - Fax:631-853-2350
Practice Address - Street 1:50 LASER CT.
Practice Address - Street 2:50 LASER CT.
Practice Address - City:HAUPPAUGE
Practice Address - State:NY
Practice Address - Zip Code:11788-9623
Practice Address - Country:US
Practice Address - Phone:631-853-2337
Practice Address - Fax:631-853-2350
Is Sole Proprietor?:No
Enumeration Date:2012-07-16
Last Update Date:2012-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator