Healthcare Provider Details

I. General information

NPI: 1548561277
Provider Name (Legal Business Name): MATTHEW JOSEPH VICARIO CMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/11/2010
Last Update Date: 11/05/2026
Certification Date: 11/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 E 5600 S STE 209
MURRAY UT
84107-8126
US

IV. Provider business mailing address

4760 S WOODDUCK LN
SALT LAKE CITY UT
84117-4935
US

V. Phone/Fax

Practice location:
  • Phone: 801-946-2323
  • Fax:
Mailing address:
  • Phone: 801-946-2323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number5170621-6004
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: