Provider Demographics
NPI:1740668763
Name:TSOURIS, VIVI E (LCSW)
Entity type:Individual
Prefix:
First Name:VIVI
Middle Name:E
Last Name:TSOURIS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27110 GRAND CENTRAL PKWY APT 28T
Mailing Address - Street 2:
Mailing Address - City:FLORAL PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11005-1228
Mailing Address - Country:US
Mailing Address - Phone:631-645-5175
Mailing Address - Fax:
Practice Address - Street 1:27110 GRAND CENTRAL PKWY APT 28T
Practice Address - Street 2:
Practice Address - City:FLORAL PARK
Practice Address - State:NY
Practice Address - Zip Code:11005-1228
Practice Address - Country:US
Practice Address - Phone:631-645-5175
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-11
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA66329104100000X
NY093872-01104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker