Healthcare Provider Details

I. General information

NPI: 1376488122
Provider Name (Legal Business Name): VIVECA JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2026
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3221 CHIQUITA BLVD S
CAPE CORAL FL
33914-4288
US

IV. Provider business mailing address

3221 CHIQUITA BLVD S
CAPE CORAL FL
33914-4288
US

V. Phone/Fax

Practice location:
  • Phone: 239-910-0712
  • Fax: 855-237-3130
Mailing address:
  • Phone: 239-910-0712
  • Fax: 855-237-3130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-530019
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: