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General NPI Number Information
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NPI Number | 1255682266
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Entity Type | Individual
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Provider Name | VIVIAN MATHIS LCSW
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Gender | Female
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Dates
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Enumeration Date | 10/01/2012
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Last Update Date | 10/22/2012
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Provider Practice Location Address
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Address Line | 4835 HOLLYWOOD BLVD SUITE 2
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City | HOLLYWOOD
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State | FL
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Zip | 33021-6548
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Country | US
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Telephone | 954-536-3154
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Fax |
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Provider Business Mailing Address
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Address Line | 659 VISTA MEADOWS DR
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City | WESTON
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State | FL
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Zip | 33327-1836
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Country | US
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Telephone | 954-536-3154
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SW5914
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License Number State | FL
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