Healthcare Provider Details

I. General information

NPI: 1568501773
Provider Name (Legal Business Name): DONNA A VIGNOLA LCSW - R
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 E BETHPAGE RD
PLAINVIEW NY
11803-4221
US

IV. Provider business mailing address

819 MONROE ST
WEST HEMPSTEAD NY
11552-3820
US

V. Phone/Fax

Practice location:
  • Phone: 516-293-2016
  • Fax:
Mailing address:
  • Phone: 516-486-8285
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR023706-1
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier01476806
Identifier TypeMEDICAID
Identifier StateNY
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: