Healthcare Provider Details

I. General information

NPI: 1740574367
Provider Name (Legal Business Name): VIANEY MIDGETTE PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: VIANEY ACEVEDO PHD

II. Dates (important events)

Enumeration Date: 05/31/2011
Last Update Date: 06/07/2024
Certification Date: 06/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

351 E TEMPLE ST
LOS ANGELES CA
90012-3328
US

IV. Provider business mailing address

351 E TEMPLE ST
LOS ANGELES CA
90012-3328
US

V. Phone/Fax

Practice location:
  • Phone: 213-253-2677
  • Fax:
Mailing address:
  • Phone: 213-253-2677
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY24887
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPSY24887
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License NumberPSY24887
License Number StateCA
# 6
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY24887
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: