Provider Demographics
NPI:1487317111
Name:REID, VIVEN RENARD I
Entity type:Individual
Prefix:
First Name:VIVEN
Middle Name:RENARD
Last Name:REID
Suffix:I
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:358 NEPPERHAN AVE
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701-6524
Mailing Address - Country:US
Mailing Address - Phone:914-843-3079
Mailing Address - Fax:
Practice Address - Street 1:41D EDGEWATER PARK
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10465-3509
Practice Address - Country:US
Practice Address - Phone:914-662-7301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-19
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0000000101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health