Provider Demographics
NPI:1841727781
Name:FLAHERTY, VIVIAN LOUISE
Entity type:Individual
Prefix:
First Name:VIVIAN
Middle Name:LOUISE
Last Name:FLAHERTY
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 1:2636 MARTIN LUTHER KING JR. WAY
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94704
Mailing Address - Country:US
Mailing Address - Phone:510-981-5273
Mailing Address - Fax:510-981-5265
Practice Address - Street 1:2636 MARTIN LUTHER KING JR. WAY
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94704
Practice Address - Country:US
Practice Address - Phone:510-981-5273
Practice Address - Fax:510-981-5265
Is Sole Proprietor?:No
Enumeration Date:2017-05-22
Last Update Date:2018-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst