Individual
MRS. MICHELE VIVONA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
252 ISLIP AVE, ISLIP, NY 11751-3029
(631) 581-6800
Mailing address
148 MALTS AVE, WEST ISLIP, NY 11795-2510
(631) 219-4443
Taxonomy
Speciality
Code
Description
License number
State
103TS0200X
School Psychologist
Primary
—
—
Other
Enumeration date
09/20/2012
Last updated
09/20/2012
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