Doctor Name: | MS. JOY ANN VIVIAN |
NPI Number: | 1053657833 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LICSW |
License Number: | 02425 |
Business Practice Address: | 107 Paul Ave N Cologne, MN - 553229330 |
Business Phone Number: | 9523619700 |
Business Fax Number: | |
Mailing Address: | 107 Paul Ave N, COLOGNE |
State: | MN |
Postal Code: | 553229330 |
Phone Number: | 9523619700 |
Fax Number: | |
NPI Enumeration Date: | 12/23/2012 |
NPI Last Update Date: | 12/23/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | 02425 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MN |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |