Provider Demographics
NPI:1932108420
Name:NERVIANO, VINCENT J (PHD)
Entity Type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:J
Last Name:NERVIANO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2660 VERANDAH LN
Mailing Address - Street 2:APT 316
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76006-3207
Mailing Address - Country:US
Mailing Address - Phone:717-579-2349
Mailing Address - Fax:
Practice Address - Street 1:2660 VERANDAH LN
Practice Address - Street 2:APT 316
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76006-3207
Practice Address - Country:US
Practice Address - Phone:717-579-2349
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-18
Last Update Date:2014-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS005722L103T00000X, 103TC0700X, 103TC1900X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
83925Medicare ID - Type Unspecified