Basic Information
| Provider Information | |||||||||
| NPI: | 1386794006 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GERARD | ||||||||
| FirstName: | VIVIAN | ||||||||
| MiddleName: | KAREN | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | NP, LCSWE AND RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7 NORTH ERIE STREET | ||||||||
| Address2: | |||||||||
| City: | MAYVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 14757 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7167534104 | ||||||||
| FaxNumber: | 7167534230 | ||||||||
| Practice Location | |||||||||
| Address1: | 7 NORTH ERIE STREET | ||||||||
| Address2: | |||||||||
| City: | MAYVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 14757 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7167534104 | ||||||||
| FaxNumber: | 7167534230 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/12/2007 | ||||||||
| LastUpdateDate: | 03/10/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | R0384571 | NY | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 163W00000X | 3897821 | NY | N | Nursing Service Providers | Registered Nurse | 363LP0808X | F401287-1 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.