1235305210 NPI number — CAROLYN I VICCHIULLO PSYD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235305210 NPI number — CAROLYN I VICCHIULLO PSYD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAROLYN I VICCHIULLO PSYD
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1235305210
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/31/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2030 LEHIGH ST
Provider Second Line Business Mailing Address:
SUITE 107
Provider Business Mailing Address City Name:
EASTON
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18042-3853
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-253-8900
Provider Business Mailing Address Fax Number:
610-253-7062

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2030 LEHIGH ST
Provider Second Line Business Practice Location Address:
SUITE 107
Provider Business Practice Location Address City Name:
EASTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18042-3853
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-253-8900
Provider Business Practice Location Address Fax Number:
610-253-7062
Provider Enumeration Date:
04/30/2008

Additional Information

Authorized Official

Authorized Official Last Name:
VICCHIULLO
Authorized Official First Name:
CAROLYN
Authorized Official Middle Name:
IRMA
Authorized Official Title or Position:
PSYCHOLOGIST
Authorized Official Telephone Number:
610-253-8900

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  PS015116 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1765117 . This is a "HIGHMARK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 03183600 . This is a "CBC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 262019000 . This is a "MAGELLAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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