Provider Demographics
NPI:1629889282
Name:VIVAR, LIDIA ESTHER
Entity type:Individual
Prefix:
First Name:LIDIA
Middle Name:ESTHER
Last Name:VIVAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LIDIA
Other - Middle Name:ESTHER
Other - Last Name:VIVAR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RBT
Mailing Address - Street 1:2490 MAVERICK ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89108-3824
Mailing Address - Country:US
Mailing Address - Phone:702-799-1883
Mailing Address - Fax:
Practice Address - Street 1:2490 MAVERICK ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89108-3824
Practice Address - Country:US
Practice Address - Phone:702-799-1883
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-14
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4154106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician