Healthcare Provider Details

I. General information

NPI: 1093135923
Provider Name (Legal Business Name): CHRISTINE VAZZANO L.P.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2014
Last Update Date: 04/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 REGENT ST BLDG 5S
LIVINGSTON NJ
07039-1675
US

IV. Provider business mailing address

5 REGENT ST BLDG 5S
LIVINGSTON NJ
07039-1675
US

V. Phone/Fax

Practice location:
  • Phone: 908-872-1462
  • Fax:
Mailing address:
  • Phone: 908-872-1462
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number37PC00490300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: