Provider Demographics
NPI:1417280504
Name:ANDERSON, VIVIEN KEIL (PHD)
Entity type:Individual
Prefix:DR
First Name:VIVIEN
Middle Name:KEIL
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:VIVIEN
Other - Middle Name:
Other - Last Name:KEIL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:3020 CHILDRENS WAY # MC5170
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-4223
Mailing Address - Country:US
Mailing Address - Phone:585-576-1700
Mailing Address - Fax:
Practice Address - Street 1:477 N EL CAMINO REAL STE D306
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-1370
Practice Address - Country:US
Practice Address - Phone:858-966-8461
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-08
Last Update Date:2024-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY22347103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical