Individual
BETHANY VIVO-PELLICCIA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
11 PINE ST APT 214, MONTCLAIR, NJ 07042-4373
(973) 988-3755
Mailing address
11 PINE ST APT 214, MONTCLAIR, NJ 07042-4373
(973) 988-3755
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
012059
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
854258486
NA
NJ
Enumeration date
09/22/2021
Last updated
09/22/2021
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