Healthcare Provider Details

I. General information

NPI: 1457405078
Provider Name (Legal Business Name): MICHAEL ANTHONY VIGORITO MFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 07/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1660 L ST NW STE 503
WASHINGTON DC
20036-5603
US

IV. Provider business mailing address

3000 CONNECTICUT AVE NW STE 134
WASHINGTON DC
20008-2509
US

V. Phone/Fax

Practice location:
  • Phone: 619-459-1688
  • Fax: 888-881-0137
Mailing address:
  • Phone: 202-417-7171
  • Fax: 888-881-0137

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC41512
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFT0000153
License Number StateDC
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLC5169
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: