Healthcare Provider Details

I. General information

NPI: 1760003982
Provider Name (Legal Business Name): VIVIANA ARENAS LCAT, ATR-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2020
Last Update Date: 12/12/2021
Certification Date: 12/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8900 VAN WYCK EXPY
RICHMOND HILL NY
11418-2832
US

IV. Provider business mailing address

11937 METROPOLITAN AVE APT 3K
KEW GARDENS NY
11415-2626
US

V. Phone/Fax

Practice location:
  • Phone: 718-206-6000
  • Fax:
Mailing address:
  • Phone: 347-886-1723
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number002429
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: