Healthcare Provider Details

I. General information

NPI: 1093725939
Provider Name (Legal Business Name): MICHELE ANN VIGEANT LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 08/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2291 VICTORY BLVD LOWER LEVEL
STATEN ISLAND NY
10314-6625
US

IV. Provider business mailing address

2291 VICTORY BLVD LOWER LEVEL
STATEN ISLAND NY
10314-6625
US

V. Phone/Fax

Practice location:
  • Phone: 646-506-5339
  • Fax:
Mailing address:
  • Phone: 646-506-5339
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number001035-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: