MEDICARE: MS. CAROL LINDA VIDETTI LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	44SC05930100	NJ

General Provider Information

NPI Number	:	1861019382
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CAROL LINDA VIDETTI LCSW

Provider Business Mailing Address
First Line	:	29 HIGH ST
Second Line	:
City	:	ALLENDALE
State	:	NJ
Zip	:	07401-1511
Country	:	US
Telephone Number	:	201-327-1228
Fax Number	:	201-327-3828

Provider Business Practice Location Address
First Line	:	29 HIGH ST
Second Line	:
City	:	ALLENDALE
State	:	NJ
Zip	:	07401-1511
Country	:	US
Telephone Number	:	201-632-3750
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/30/2020
Last Update Date	:	06/30/2020

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