Provider Demographics
NPI:1821773060
Name:RIVERA-VARGAS, VIVIANA B (PSYD)
Entity Type:Individual
Prefix:
First Name:VIVIANA
Middle Name:B
Last Name:RIVERA-VARGAS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 S 17TH ST STE 1601
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-6216
Mailing Address - Country:US
Mailing Address - Phone:267-209-3209
Mailing Address - Fax:
Practice Address - Street 1:255 S 17TH ST STE 1601
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-6216
Practice Address - Country:US
Practice Address - Phone:267-209-3209
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-15
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist