Healthcare Provider Details

I. General information

NPI: 1427303361
Provider Name (Legal Business Name): VIVICA MONDRIAN TAYLOR LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2012
Last Update Date: 04/21/2025
Certification Date: 04/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

172 GORDON RD
WALNUT CREEK CA
94598-4802
US

IV. Provider business mailing address

172 GORDON RD
WALNUT CREEK CA
94598-4802
US

V. Phone/Fax

Practice location:
  • Phone: 925-262-3993
  • Fax:
Mailing address:
  • Phone: 925-262-3993
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number89154
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: