MEDICARE: NADINE VIVARELLI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TB0200X	Cognitive & Behavioral Psychologist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083026058
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NADINE VIVARELLI

Provider Business Mailing Address
First Line	:	2655 S RAIBOW BLVD
Second Line	:	#407
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-5100
Country	:	US
Telephone Number	:	702-750-2682
Fax Number	:	702-750-9180

Provider Business Practice Location Address
First Line	:	2655 S RAIBOW BLVD
Second Line	:	#407
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-5100
Country	:	US
Telephone Number	:	702-750-2682
Fax Number	:	702-750-9180

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/27/2014
Last Update Date	:	05/27/2014

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Directions to “ NADINE VIVARELLI ” Practice Location

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