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General NPI Number Information
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NPI Number | 1235635244
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Entity Type | Organization
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Legal Business Name | VIVA WELLNESS LLC
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Dates
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Enumeration Date | 03/30/2018
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Last Update Date | 03/30/2018
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Provider Practice Location Address
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Address Line | 195 MONTAGUE ST
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City | BROOKLYN
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State | NY
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Zip | 11201-3628
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Country | US
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Telephone | 646-598-9955
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Fax |
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Provider Business Mailing Address
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Address Line | 114 W 81ST ST APT GF
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City | NEW YORK
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State | NY
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Zip | 10024-5928
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Country | US
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Telephone | 917-838-9803
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Fax |
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Authorized Official
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Title or Position | CO-OWNER
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Name | RACHEL GERSTEN
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Credential | LMHC
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Telephone | 917-838-9803
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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 | 005426
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number |
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License Number State |
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