Individual
CHANEL VIVIANA TAZZA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMHC
Contact information
Practice address
5913 GROVE ST, RIDGEWOOD, NY 11385-2647
(646) 456-0819
(718) 297-8658
Mailing address
63 SCUDDERS LN, GLEN HEAD, NY 11545-1535
(646) 456-0819
(718) 297-8658
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YM0800X
Mental Health Counselor
004161
NY
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00-4161
NYS MENTAL HEALTH COUNSELOR LICENSE
NY
01
—
006801
STATE LICENSE
CT
05
—
07679601
—
NY
01
—
1053510354
NPI
—
01
—
37PC00991600
STATE LICENSE
NJ
Enumeration date
07/16/2007
Last updated
03/28/2024
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