Provider Demographics
NPI:1477203305
Name:VIGLIONE, CARLY ANTOINE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:CARLY
Middle Name:ANTOINE
Last Name:VIGLIONE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 MALCOLM ST
Mailing Address - Street 2:
Mailing Address - City:WALDWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:07463-2414
Mailing Address - Country:US
Mailing Address - Phone:201-618-8777
Mailing Address - Fax:
Practice Address - Street 1:301 SICOMAC AVENUE
Practice Address - Street 2:
Practice Address - City:WYCKOFF
Practice Address - State:NJ
Practice Address - Zip Code:07481-0748
Practice Address - Country:US
Practice Address - Phone:201-848-5883
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-24
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC058205001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical