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General NPI Number Information
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NPI Number | 1477203305
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Entity Type | Individual
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Provider Name | CARLY ANTOINE VIGLIONE LCSW
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Gender | Female
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Dates
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Enumeration Date | 03/24/2022
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Last Update Date | 03/24/2022
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Provider Practice Location Address
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Address Line | 301 SICOMAC AVENUE
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City | WYCKOFF
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State | NJ
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Zip | 07481-0748
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Country | US
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Telephone | 201-848-5883
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Fax |
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Provider Business Mailing Address
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Address Line | 15 MALCOLM ST
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City | WALDWICK
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State | NJ
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Zip | 07463-2414
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Country | US
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Telephone | 201-618-8777
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 44SC05820500
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License Number State | NJ
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