Active NPI
Katherine H Vivanco, EDM, MSW, LCSW
- Clinical Social Worker
- Stamford, CT
National Provider Identifier
1710189105
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 7121
- Practice address
- 2001 W Main St
Suite 106B
Stamford, CT 06902-4501 - Phone
- (203) 321-9119
- NPI assigned
- Jun 5, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 7121 | CT | Primary |
Addresses
Primary practice location
2001 W Main St
Suite 106B
Stamford, CT 06902-4501
Mailing address
2001 W Main St
Suite 106B
Stamford, CT 06902-4501
Phone (203) 321-9119
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7121 | CT | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1181001600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1252022400000",
"number": "1710189105",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2001 W MAIN ST",
"address_2": "SUITE 106B",
"city": "STAMFORD",
"state": "CT",
"postal_code": "069024501",
"telephone_number": "203-321-9119"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2001 W MAIN ST",
"address_2": "SUITE 106B",
"city": "STAMFORD",
"state": "CT",
"postal_code": "069024501",
"telephone_number": "203-321-9119"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VIVANCO",
"first_name": "KATHERINE",
"middle_name": "H",
"name_prefix": "Ms.",
"credential": "EDM, MSW, LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-06-05",
"last_updated": "2009-09-04",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CT",
"license": "7121",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Stamford, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.