Basic Information
| Provider Information | |||||||||
| NPI: | 1104252279 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GEISELER | ||||||||
| FirstName: | VIVIAN | ||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 14624 SHERMAN WAY STE 508 | ||||||||
| Address2: | |||||||||
| City: | VAN NUYS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 914052289 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8189084990 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 14624 SHERMAN WAY STE 508 | ||||||||
| Address2: | |||||||||
| City: | VAN NUYS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 914052289 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8189084990 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2013 | ||||||||
| LastUpdateDate: | 12/11/2020 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | 06/03/2020 | ||||||||
| NPIReactivationDate: | 06/09/2020 | ||||||||
| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 12/11/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | ASW94763 | CA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.