Healthcare Provider Details

I. General information

NPI: 1912175191
Provider Name (Legal Business Name): VANESSA A. VIGILANTE PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2008
Last Update Date: 11/21/2024
Certification Date: 11/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 FOULK RD APT 4C6
WILMINGTON DE
19803-3826
US

IV. Provider business mailing address

400 FOULK RD APT 4C6
WILMINGTON DE
19803-3826
US

V. Phone/Fax

Practice location:
  • Phone: 302-272-5508
  • Fax:
Mailing address:
  • Phone: 302-272-5508
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPS016365
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPS016365
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberB10000809
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: