MEDICARE: ARIANNY VIDAL MA

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1568114882
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ARIANNY VIDAL MA

Provider Business Mailing Address
First Line	:	2744 NORTHVIEW RD
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19152-1611
Country	:	US
Telephone Number	:	215-552-7029
Fax Number	:

Provider Business Practice Location Address
First Line	:	2744 NORTHVIEW RD
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19152-1611
Country	:	US
Telephone Number	:	215-552-7029
Fax Number	:

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

Provider Enumeration Date	:	01/19/2022
Last Update Date	:	01/19/2022

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