Provider Demographics
NPI:1083940134
Name:KOSTOLNI, VINCENT P (LMHC, NCC, CASAC-T)
Entity Type:Individual
Prefix:MR
First Name:VINCENT
Middle Name:P
Last Name:KOSTOLNI
Suffix:
Gender:M
Credentials:LMHC, NCC, CASAC-T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 GARDENIA LN
Mailing Address - Street 2:
Mailing Address - City:LEVITTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11756-3306
Mailing Address - Country:US
Mailing Address - Phone:518-744-4729
Mailing Address - Fax:
Practice Address - Street 1:18 GARDENIA LN
Practice Address - Street 2:
Practice Address - City:LEVITTOWN
Practice Address - State:NY
Practice Address - Zip Code:11756-3306
Practice Address - Country:US
Practice Address - Phone:518-744-4729
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-25
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004313101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health