MEDICARE: DR. VIVIANA G LITOVSKY PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	35SI00254600	NJ

General Provider Information

NPI Number	:	1043265960
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VIVIANA G LITOVSKY PH.D.

Provider Business Mailing Address
First Line	:	792 CHIMNEY ROCK RD STE C
Second Line	:
City	:	MARTINSVILLE
State	:	NJ
Zip	:	08836-2271
Country	:	US
Telephone Number	:	732-356-8855
Fax Number	:	732-356-0067

Provider Business Practice Location Address
First Line	:	792 CHIMNEY ROCK RD STE C
Second Line	:
City	:	MARTINSVILLE
State	:	NJ
Zip	:	08836-2271
Country	:	US
Telephone Number	:	732-356-8855
Fax Number	:	732-356-0067

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2006
Last Update Date	:	01/15/2021

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