Provider Demographics
NPI:1114717006
Name:EMILE, VIVIANA EMMANUELA
Entity type:Individual
Prefix:MRS
First Name:VIVIANA
Middle Name:EMMANUELA
Last Name:EMILE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1244 PACIFIC ST APT 4A
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11216-5612
Mailing Address - Country:US
Mailing Address - Phone:347-383-0763
Mailing Address - Fax:
Practice Address - Street 1:535 CLINTON AVE STE 2
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11238-6590
Practice Address - Country:US
Practice Address - Phone:718-704-1986
Practice Address - Fax:347-725-3316
Is Sole Proprietor?:No
Enumeration Date:2025-05-12
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP134704101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health