Healthcare Provider Details

I. General information

NPI: 1669655338
Provider Name (Legal Business Name): MARIA VERNACHIO MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/17/2007
Last Update Date: 12/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 ATLANTIC CITY BLVD
BEACHWOOD NJ
08722-4007
US

IV. Provider business mailing address

625 ATLANTIC CITY BLVD
BEACHWOOD NJ
08722-4007
US

V. Phone/Fax

Practice location:
  • Phone: 732-737-1158
  • Fax: 848-480-2833
Mailing address:
  • Phone: 732-737-1158
  • Fax: 848-480-2833

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC01304300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: