Vivian Ana Loretdemola, PH.D

Primary specialty

PsychologistTaxonomy code 103T00000X

License

PY5437 Issued in FL

Practice address

3599 W. Lake Mary Blvd, Suite B2
Lake Mary, FL 32746

Phone

(386) 675-7467

Fax

(386) 256-3665

NPI assigned

Dec 15, 2017

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other names 1

• Dr. Vivian Ana Roy Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1513296000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1513296000000",
    "number": "1891201638",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1502 N. PENINSULA DRIVE",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "32118",
            "telephone_number": "386-675-7467",
            "fax_number": "386-256-3665"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3599 W. LAKE MARY BLVD, SUITE B2",
            "city": "LAKE MARY",
            "state": "FL",
            "postal_code": "32746",
            "telephone_number": "386-675-7467",
            "fax_number": "386-256-3665"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LORETDEMOLA",
        "first_name": "VIVIAN",
        "middle_name": "ANA",
        "name_prefix": "Dr.",
        "credential": "PH.D",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-12-15",
        "last_updated": "2017-12-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "FL",
            "license": "PY5437",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "FL",
            "license": "PY5437",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "VIVIAN",
            "last_name": "ROY",
            "middle_name": "ANA",
            "prefix": "DR.",
            "credential": "PH.D.",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

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• Psychologist in Lake Mary, FL
• Providers in Lake Mary, FL by specialty
• Psychologist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2017; 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.