Healthcare Provider Details

I. General information

NPI: 1437412939
Provider Name (Legal Business Name): DARLA JEAN VIGILANTE DILORENZO PSYD., BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MS. DARLA JEAN VIGILANTE

II. Dates (important events)

Enumeration Date: 06/19/2012
Last Update Date: 12/31/2025
Certification Date: 12/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

935 NORTHERN BLVD
GREAT NECK NY
11021-5316
US

IV. Provider business mailing address

PO BOX 2256
HALESITE NY
11743-0889
US

V. Phone/Fax

Practice location:
  • Phone: 516-487-7116
  • Fax:
Mailing address:
  • Phone: 347-416-0605
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number027858
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number1124468
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-20-41122
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: