Individual
MS. KATHERINE H VIVANCO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
EDM, MSW, LCSW
Contact information
Practice address
2001 W MAIN ST, SUITE 106B, STAMFORD, CT 06902-4501
(203) 321-9119
Mailing address
2001 W MAIN ST, SUITE 106B, STAMFORD, CT 06902-4501
(203) 321-9119
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
7121
CT
Other
Enumeration date
06/05/2007
Last updated
09/04/2009
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