Individual provider Active NPI

Melissa Angela Vivino, PH.D.

  • Clinical Psychologist
  • New York, NY
National Provider Identifier
1316181886
Registry record updated Aug 6, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
012964 Issued in NY
Practice address
915 W End Ave
Apt 6F
New York, NY 10025-3535
Phone
(516) 521-3940
NPI assigned
Apr 28, 2009
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 6, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 012964 NY Primary

Addresses

Primary practice location

915 W End Ave
Apt 6F
New York, NY 10025-3535

Mailing address

915 W End Ave
Apt 6F
New York, NY 10025-3535
Phone (516) 521-3940

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
012964NYMDClinical Psychologist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1240876800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1407283200000",
    "number": "1316181886",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "915 W END AVE",
            "address_2": "APT 6F",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100253535",
            "telephone_number": "516-521-3940"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "915 W END AVE",
            "address_2": "APT 6F",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100253535",
            "telephone_number": "516-521-3940"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VIVINO",
        "first_name": "MELISSA",
        "middle_name": "ANGELA",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-04-28",
        "last_updated": "2014-08-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NY",
            "license": "012964",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.