Healthcare Provider Details

I. General information

NPI: 1992193049
Provider Name (Legal Business Name): STEPHANIE VIGOYA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/23/2014
Last Update Date: 06/15/2020
Certification Date: 06/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2250 WALTON AVENUE
BRONX NY
10451
US

IV. Provider business mailing address

101 HAMILTON AVE
AUBURN NY
13021-5028
US

V. Phone/Fax

Practice location:
  • Phone: 646-946-5077
  • Fax:
Mailing address:
  • Phone: 646-946-5077
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberP91250
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number007176
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: