Provider Demographics
NPI:1831202811
Name:VIVIANO, ROSE BERNADETTE (LMFT)
Entity type:Individual
Prefix:MS
First Name:ROSE
Middle Name:BERNADETTE
Last Name:VIVIANO
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11711 MEMORIAL DR
Mailing Address - Street 2:#607
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-7255
Mailing Address - Country:US
Mailing Address - Phone:832-242-2988
Mailing Address - Fax:
Practice Address - Street 1:10435 GREENBOUGH DR
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:TX
Practice Address - Zip Code:77477-5000
Practice Address - Country:US
Practice Address - Phone:281-207-2445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4639106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1462441801Medicaid