Provider Demographics
NPI:1235306069
Name:BADER, VIVIAN SARAH (LCSW)
Entity type:Individual
Prefix:MS
First Name:VIVIAN
Middle Name:SARAH
Last Name:BADER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 W. 70TH ST
Mailing Address - Street 2:APT 6-D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-4417
Mailing Address - Country:US
Mailing Address - Phone:646-662-8571
Mailing Address - Fax:
Practice Address - Street 1:120 W. 70TH ST
Practice Address - Street 2:APT 6-D
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-4417
Practice Address - Country:US
Practice Address - Phone:646-662-8571
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-12
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR031348-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health