Provider Demographics
NPI:1255902979
Name:NGUYEN, VYVIAN (LMSW)
Entity type:Individual
Prefix:
First Name:VYVIAN
Middle Name:
Last Name:NGUYEN
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 1:901 W HICKORY ST
Mailing Address - Street 2:
Mailing Address - City:DEMING
Mailing Address - State:NM
Mailing Address - Zip Code:88030-4046
Mailing Address - Country:US
Mailing Address - Phone:575-546-2174
Mailing Address - Fax:
Practice Address - Street 1:901 W HICKORY ST
Practice Address - Street 2:
Practice Address - City:DEMING
Practice Address - State:NM
Practice Address - Zip Code:88030-4046
Practice Address - Country:US
Practice Address - Phone:575-546-2174
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-03
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM-0118SWB-20230104100000X
NMX11-346104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMPHPK2206112Medicaid