Healthcare Provider Details

I. General information

NPI: 1043145865
Provider Name (Legal Business Name): VIVIENNE MARTINE DIETRICH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 BELDEN AVE STE 4
NORWALK CT
06850-3314
US

IV. Provider business mailing address

47 THISTLE ROCK DR
GUILFORD CT
06437-1606
US

V. Phone/Fax

Practice location:
  • Phone: 203-772-8161
  • Fax:
Mailing address:
  • Phone: 201-785-4914
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: