Provider Demographics
NPI:1740219666
Name:VIGNA, CAROL SUSAN (LCSW)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:SUSAN
Last Name:VIGNA
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 1:214 COLLEGE PARK PLZ
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15904-2833
Mailing Address - Country:US
Mailing Address - Phone:814-262-0025
Mailing Address - Fax:814-266-8745
Practice Address - Street 1:214 COLLEGE PARK PLZ
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15904-2833
Practice Address - Country:US
Practice Address - Phone:814-262-0025
Practice Address - Fax:814-266-8745
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0136921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAS22076Medicare UPIN
PA786516PTYMedicare ID - Type Unspecified