Provider Demographics
NPI:1669655338
Name:VERNACHIO, MARIA (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:VERNACHIO
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 ATLANTIC CITY BLVD
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08722-4007
Mailing Address - Country:US
Mailing Address - Phone:732-737-1158
Mailing Address - Fax:848-480-2833
Practice Address - Street 1:625 ATLANTIC CITY BLVD
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08722-4007
Practice Address - Country:US
Practice Address - Phone:732-737-1158
Practice Address - Fax:848-480-2833
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-17
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC013043001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ123613Medicare PIN