| Vivian Ryu Lcsw Pllc | |
|
2300 E Fry Blvd Sierra Vista AZ 85635-2712 | |
| (520) 559-4976 | |
| Not Available |
| Full Name | Vivian Ryu Lcsw Pllc |
|---|---|
| Speciality | Clinic/Center |
| Location | 2300 E Fry Blvd, Sierra Vista, Arizona |
| Authorized Official Name and Position | Vivian Ryu (THERAPIST) |
| Authorized Official Contact | 5202206009 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Vivian Ryu Lcsw Pllc Po Box 3822 Sierra Vista AZ 85636-3822 Ph: (520) 220-6009 | Vivian Ryu Lcsw Pllc 2300 E Fry Blvd Sierra Vista AZ 85635-2712 Ph: (520) 559-4976 |
| NPI Number | 1962030833 |
|---|---|
| Provider Enumeration Date | 03/27/2020 |
| Last Update Date | 03/27/2020 |
| Certification Date | 03/27/2020 |
| Medicare PECOS PAC ID | 1456782895 |
|---|---|
| Medicare Enrollment ID | O20200519000648 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962030833 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Vivian Ryu |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1700397411 PECOS PAC ID: 9436418324 Enrollment ID: I20180123001319 |
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