Provider Demographics
NPI:1699890780
Name:VILLAVERDE, VIVIEN MOSQUEDA (LCSW, PPSC)
Entity type:Individual
Prefix:MS
First Name:VIVIEN
Middle Name:MOSQUEDA
Last Name:VILLAVERDE
Suffix:
Gender:F
Credentials:LCSW, PPSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:SCHOOL MENTAL HEALTH
Mailing Address - Street 2:439 WEST 97TH STREET
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90003
Mailing Address - Country:US
Mailing Address - Phone:323-754-2856
Mailing Address - Fax:
Practice Address - Street 1:LAUSD SCHOOL MENTAL HEALTH
Practice Address - Street 2:439 WEST 97TH STREET
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90003
Practice Address - Country:US
Practice Address - Phone:323-754-2856
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS216831041C0700X
CAPPSC1041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAEPS012780OtherMEDI-CAL