Provider Demographics
NPI:1962012013
Name:VIVIRITO, KRISTI M (PSYD)
Entity type:Individual
Prefix:DR
First Name:KRISTI
Middle Name:M
Last Name:VIVIRITO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11151 VALLEYVIEW DR
Mailing Address - Street 2:PO BOX 501
Mailing Address - City:BRISTOW
Mailing Address - State:VA
Mailing Address - Zip Code:20136-0501
Mailing Address - Country:US
Mailing Address - Phone:406-580-5603
Mailing Address - Fax:
Practice Address - Street 1:1421 WIEHLE AVE
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-3830
Practice Address - Country:US
Practice Address - Phone:540-316-0409
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-04
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist