MEDICARE: HARMILA VIALVA MA

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	101Y00000X	Counselor

General Provider Information

NPI Number	:	1568606457
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HARMILA VIALVA MA

Provider Business Mailing Address
First Line	:	188 BEACH 115 ST
Second Line	:	APT 1
City	:	ROCKAWAY
State	:	NY
Zip	:	11694-0191
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	188 BEACH 115TH ST
Second Line	:	APT 1
City	:	ROCKAWAY PARK
State	:	NY
Zip	:	11694-2408
Country	:	US
Telephone Number	:	646-250-7969
Fax Number	:

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

Provider Enumeration Date	:	04/23/2009
Last Update Date	:	04/23/2009

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Directions to “ HARMILA VIALVA MA” Practice Location

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