MEDICARE: CAROL SUSAN VIGNA LCSW

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	1041C0700X	Clinical Social Worker	CW013692	PA

General Provider Information

NPI Number	:	1740219666
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROL SUSAN VIGNA LCSW

Provider Business Mailing Address
First Line	:	214 COLLEGE PARK PLZ
Second Line	:
City	:	JOHNSTOWN
State	:	PA
Zip	:	15904-2833
Country	:	US
Telephone Number	:	814-262-0025
Fax Number	:	814-266-8745

Provider Business Practice Location Address
First Line	:	214 COLLEGE PARK PLZ
Second Line	:
City	:	JOHNSTOWN
State	:	PA
Zip	:	15904-2833
Country	:	US
Telephone Number	:	814-262-0025
Fax Number	:	814-266-8745

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

Provider Enumeration Date	:	07/02/2006
Last Update Date	:	07/08/2007

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