Provider Demographics
NPI:1184034050
Name:TEJERA, VIVIAN (LICSW, LCSW)
Entity type:Individual
Prefix:MRS
First Name:VIVIAN
Middle Name:
Last Name:TEJERA
Suffix:
Gender:
Credentials:LICSW, LCSW
Other - Prefix:
Other - First Name:VIVIAN
Other - Middle Name:
Other - Last Name:LACY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12025 115TH AVE NE STE 200
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-6935
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12025 115TH AVE NE STE 200
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-6935
Practice Address - Country:US
Practice Address - Phone:425-821-1810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-01
Last Update Date:2025-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0183021041C0700X
FLSW204241041C0700X
FL222Q00000X
WALW616705781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist