MEDICARE: VIVIANA ANDREA MCKENNEY

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	103T00000X	Psychologist	94027274	CA

General Provider Information

NPI Number	:	1144927807
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VIVIANA ANDREA MCKENNEY

Provider Business Mailing Address
First Line	:	3132 DALEMEAD ST
Second Line	:
City	:	TORRANCE
State	:	CA
Zip	:	90505-6919
Country	:	US
Telephone Number	:	310-896-1874
Fax Number	:

Provider Business Practice Location Address
First Line	:	70 S LAKE AVE STE 810
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91101-4738
Country	:	US
Telephone Number	:	213-839-4768
Fax Number	:

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

Provider Enumeration Date	:	02/13/2023
Last Update Date	:	12/10/2025

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