Healthcare Provider Details

I. General information

NPI: 1154496784
Provider Name (Legal Business Name): MICHAEL VIGGIANO LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17810 WEXFORD TERRACE
JAMAICA NY
11432-3050
US

IV. Provider business mailing address

6817 60 DRIVE
MASPETH NY
11378-2516
US

V. Phone/Fax

Practice location:
  • Phone: 718-658-1123
  • Fax: 718-658-7091
Mailing address:
  • Phone: 718-898-0388
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberPR0160331
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: