Healthcare Provider Details

I. General information

NPI: 1144927807
Provider Name (Legal Business Name): VIVIANA ANDREA MCKENNEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2023
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 S LAKE AVE STE 810
PASADENA CA
91101-4738
US

IV. Provider business mailing address

3132 DALEMEAD ST
TORRANCE CA
90505-6919
US

V. Phone/Fax

Practice location:
  • Phone: 213-839-4768
  • Fax:
Mailing address:
  • Phone: 310-896-1874
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number94027274
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: