MEDICARE: MRS. LANI C VIVIRITO LCSW

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	1041C0700X	Clinical Social Worker	34005019A	IN

General Provider Information

NPI Number	:	1275521106
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LANI C VIVIRITO LCSW

Provider Business Mailing Address
First Line	:	105 E JEFFERSON BLVD
Second Line	:	SUITE 700
City	:	SOUTH BEND
State	:	IN
Zip	:	46601-1922
Country	:	US
Telephone Number	:	574-232-2255
Fax Number	:	574-287-9377

Provider Business Practice Location Address
First Line	:	105 E JEFFERSON BLVD
Second Line	:	SUITE 700
City	:	SOUTH BEND
State	:	IN
Zip	:	46601-1922
Country	:	US
Telephone Number	:	574-232-2255
Fax Number	:	574-287-9377

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

Provider Enumeration Date	:	10/13/2005
Last Update Date	:	07/08/2007

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