Healthcare Provider Details

I. General information

NPI: 1326359621
Provider Name (Legal Business Name): VIVIAN KAFALENOS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: VIVI KAFALENOS

II. Dates (important events)

Enumeration Date: 07/01/2010
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 AMHERST DR NE
ALBUQUERQUE NM
87106-1302
US

IV. Provider business mailing address

123 AMHERST DR NE
ALBUQUERQUE NM
87106-1302
US

V. Phone/Fax

Practice location:
  • Phone: 505-544-9630
  • Fax:
Mailing address:
  • Phone: 505-544-9630
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberM-10475
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: