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General NPI Number Information
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NPI Number | 1205718095
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Entity Type | Individual
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Provider Name | NIDIS VIVENES
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Gender | Female
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Dates
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Enumeration Date | 07/22/2025
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Last Update Date | 07/31/2025
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Provider Practice Location Address
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Address Line | 4385 W 16TH AVE
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City | HIALEAH
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State | FL
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Zip | 33012-7628
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Country | US
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Telephone | 305-824-0637
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Fax |
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Provider Business Mailing Address
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Address Line | 1281 NE 117TH ST
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City | MIAMI SHORES
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State | FL
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Zip | 33161-6829
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | ISW19306
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 101YS0200X
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Taxonomy Name | School Counselor
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License Number | ISW19306
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 1041S0200X
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Taxonomy Name | School Social Worker
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License Number | ISW19306
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 221700000X
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Taxonomy Name | Art Therapist
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License Number | ISW19306
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License Number State | FL
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Taxonomy #5
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | ISW19306
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License Number State | FL
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