MEDICARE: MR. BENEDICT VICARISI JR JR. ED.S

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	PC01046	NJ
2	106H00000X	Marriage & Family Therapist	FI0014959	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	232752	OTHER	NJ	HEALTH NET MANAGED CARE
2	490655000	OTHER	NJ	MAGELLAN BLUE CROSS
3	P2728931	OTHER	NJ	OXFORD

General Provider Information

NPI Number	:	1144328931
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BENEDICT VICARISI JR JR. ED.S

Provider Business Mailing Address
First Line	:	69 HAZEL AVENUE
Second Line	:
City	:	WEST ORANGE
State	:	NJ
Zip	:	07052-4524
Country	:	US
Telephone Number	:	973-495-1818
Fax Number	:

Provider Business Practice Location Address
First Line	:	395 PLEASANT VALLEY WAY
Second Line	:
City	:	WEST ORANGE
State	:	NJ
Zip	:	07052-2905
Country	:	US
Telephone Number	:	973-495-1818
Fax Number	:	973-495-1818

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	11/22/2024

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Directions to “ MR. BENEDICT VICARISI JR JR. ED.S” Practice Location

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