MEDICARE: CAROL VIVORI CNP

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	364SP0809X	Adult Psychiatric/Mental Health Clinical Nurse Specialist	RN230503	MA

General Provider Information

NPI Number	:	1255722716
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROL VIVORI CNP

Provider Business Mailing Address
First Line	:	132 MASS MOCA WAY
Second Line	:
City	:	NORTH ADAMS
State	:	MA
Zip	:	01247-2446
Country	:	US
Telephone Number	:	413-664-4600
Fax Number	:	413-664-4660

Provider Business Practice Location Address
First Line	:	132 MASS MOCA WAY
Second Line	:
City	:	NORTH ADAMS
State	:	MA
Zip	:	01247-2446
Country	:	US
Telephone Number	:	413-664-4600
Fax Number	:	413-664-4660

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

Provider Enumeration Date	:	02/05/2015
Last Update Date	:	01/08/2016

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