Healthcare Provider Details

I. General information

NPI: 1407124217
Provider Name (Legal Business Name): KAIRO VIVAS LCSW-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/07/2011
Last Update Date: 02/20/2025
Certification Date: 02/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 RESERVOIR CIR STE 105
PIKESVILLE MD
21208-6362
US

IV. Provider business mailing address

8 RESERVOIR CIR STE 105
PIKESVILLE MD
21208-6362
US

V. Phone/Fax

Practice location:
  • Phone: 202-670-3704
  • Fax:
Mailing address:
  • Phone: 202-250-9008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number17447
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License NumberLC50081219
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: