Provider Demographics
NPI:1689415598
Name:RAMIREZ, VIVIAN JOHANNA (LMSW)
Entity type:Individual
Prefix:
First Name:VIVIAN
Middle Name:JOHANNA
Last Name:RAMIREZ
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:VIVIAN
Other - Middle Name:JOHANNA
Other - Last Name:RAMIREZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMSW
Mailing Address - Street 1:409 S LENZNER AVE APT 12202
Mailing Address - Street 2:
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635-5653
Mailing Address - Country:US
Mailing Address - Phone:786-585-6467
Mailing Address - Fax:
Practice Address - Street 1:2240 WINROW RD
Practice Address - Street 2:
Practice Address - City:FORT HUACHUCA
Practice Address - State:AZ
Practice Address - Zip Code:85613-5080
Practice Address - Country:US
Practice Address - Phone:786-585-6467
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-04
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX113319104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker