Provider Demographics
NPI:1164135216
Name:VICENTE, NOELIA (LSW)
Entity Type:Individual
Prefix:
First Name:NOELIA
Middle Name:
Last Name:VICENTE
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 CORNWALL RD STE 111
Mailing Address - Street 2:
Mailing Address - City:MONMOUTH JUNCTION
Mailing Address - State:NJ
Mailing Address - Zip Code:08852-2411
Mailing Address - Country:US
Mailing Address - Phone:732-419-4000
Mailing Address - Fax:
Practice Address - Street 1:1100 CORNWALL RD STE 111
Practice Address - Street 2:
Practice Address - City:MONMOUTH JUNCTION
Practice Address - State:NJ
Practice Address - Zip Code:08852-2411
Practice Address - Country:US
Practice Address - Phone:732-419-4000
Practice Address - Fax:732-305-7830
Is Sole Proprietor?:No
Enumeration Date:2023-01-04
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL06905700101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor