Provider Demographics
NPI:1396323077
Name:DANIEL, VIVIANE BERNADIN
Entity type:Individual
Prefix:
First Name:VIVIANE
Middle Name:BERNADIN
Last Name:DANIEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 CREIGHTON AVE
Mailing Address - Street 2:
Mailing Address - City:RONKONKOMA
Mailing Address - State:NY
Mailing Address - Zip Code:11779-4416
Mailing Address - Country:US
Mailing Address - Phone:631-471-2260
Mailing Address - Fax:
Practice Address - Street 1:8 CREIGHTON AVE
Practice Address - Street 2:
Practice Address - City:RONKONKOMA
Practice Address - State:NY
Practice Address - Zip Code:11779-4416
Practice Address - Country:US
Practice Address - Phone:631-471-2260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-01
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty