Provider Demographics
NPI:1861019382
Name:VIDETTI, CAROL LINDA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:LINDA
Last Name:VIDETTI
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 1:29 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:ALLENDALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07401-1511
Mailing Address - Country:US
Mailing Address - Phone:201-327-1228
Mailing Address - Fax:201-327-3828
Practice Address - Street 1:29 HIGH ST
Practice Address - Street 2:
Practice Address - City:ALLENDALE
Practice Address - State:NJ
Practice Address - Zip Code:07401-1511
Practice Address - Country:US
Practice Address - Phone:201-632-3750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-30
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC059301001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical