Healthcare Provider Details

I. General information

NPI: 1487050753
Provider Name (Legal Business Name): DINA VIGILANTE LCSW-R
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DINA CHIRICO LCSW-R

II. Dates (important events)

Enumeration Date: 11/13/2014
Last Update Date: 11/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1156 N BROADWAY
YONKERS NY
10701-1108
US

IV. Provider business mailing address

1 OLD CHESTNUT RIDGE RD
MONTVALE NJ
07645-1046
US

V. Phone/Fax

Practice location:
  • Phone: 914-965-3701
  • Fax:
Mailing address:
  • Phone: 914-552-4578
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number074979
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: