=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013639350
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VIVA WELLNESS LICENSED MENTAL HEALTH COUNSELING, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/14/2022
-----------------------------------------------------
Last Update Date | 09/14/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 300 CADMAN PLZ W FL 12
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11201-3226
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 347-689-7759
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 70 W 87TH ST APT B
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10024-3566
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-838-9803
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | RACHEL GERSTEN
-----------------------------------------------------
Credential | LMHC
-----------------------------------------------------
Telephone | 917-838-9803
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------