Healthcare Provider Details

I. General information

NPI: 1942125885
Provider Name (Legal Business Name): VIVA MIND THERAPY GROUP PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 PRIMROSE ST
INDIAN ORCHARD MA
01151-2335
US

IV. Provider business mailing address

65 PRIMROSE ST
INDIAN ORCHARD MA
01151-2335
US

V. Phone/Fax

Practice location:
  • Phone: 413-450-1610
  • Fax:
Mailing address:
  • Phone: 413-450-1610
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: LARA QUILES
Title or Position: OWNER
Credential:
Phone: 413-450-1610