Provider Demographics
NPI:1093155335
Name:TAFOLLA, VINCENT R (LMSW)
Entity Type:Individual
Prefix:
First Name:VINCENT
Middle Name:R
Last Name:TAFOLLA
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 W 16TH ST
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:KS
Mailing Address - Zip Code:67152-8125
Mailing Address - Country:US
Mailing Address - Phone:620-326-7448
Mailing Address - Fax:620-326-6662
Practice Address - Street 1:1601 W 16TH ST
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:KS
Practice Address - Zip Code:67152-8125
Practice Address - Country:US
Practice Address - Phone:620-326-7448
Practice Address - Fax:620-326-6662
Is Sole Proprietor?:No
Enumeration Date:2013-07-01
Last Update Date:2014-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS8864104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker