Provider Demographics
NPI:1487332615
Name:ULYSSE, VIVENS
Entity type:Individual
Prefix:MR
First Name:VIVENS
Middle Name:
Last Name:ULYSSE
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:VIVENS
Other - Middle Name:
Other - Last Name:ULYSSE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:28 COLUMBUS AVE
Mailing Address - Street 2:
Mailing Address - City:STOUGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02072-3214
Mailing Address - Country:US
Mailing Address - Phone:781-228-9627
Mailing Address - Fax:
Practice Address - Street 1:420 MAIN ST
Practice Address - Street 2:
Practice Address - City:WALPOLE
Practice Address - State:MA
Practice Address - Zip Code:02081-3753
Practice Address - Country:US
Practice Address - Phone:617-514-2495
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-07
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2282687363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health