Provider Demographics
NPI:1992075469
Name:DWYER, VIVIAN
Entity type:Individual
Prefix:MS
First Name:VIVIAN
Middle Name:
Last Name:DWYER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81 PARK AVE.
Mailing Address - Street 2:
Mailing Address - City:MISLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07432
Mailing Address - Country:US
Mailing Address - Phone:201-652-2790
Mailing Address - Fax:201-652-2790
Practice Address - Street 1:81 PARK AVE.
Practice Address - Street 2:
Practice Address - City:MISLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:07432
Practice Address - Country:US
Practice Address - Phone:201-652-2790
Practice Address - Fax:201-652-2790
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-30
Last Update Date:2011-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00084700101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional