Healthcare Provider Details

I. General information

NPI: 1699890780
Provider Name (Legal Business Name): VIVIEN MOSQUEDA VILLAVERDE LCSW, PPSC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 11/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

LAUSD SCHOOL MENTAL HEALTH 439 WEST 97TH STREET
LOS ANGELES CA
90003
US

IV. Provider business mailing address

SCHOOL MENTAL HEALTH 439 WEST 97TH STREET
LOS ANGELES CA
90003
US

V. Phone/Fax

Practice location:
  • Phone: 323-754-2856
  • Fax:
Mailing address:
  • Phone: 323-754-2856
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS21683
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License NumberPPSC
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: