Provider Demographics
NPI:1952632119
Name:VIGIL, ROBERT (CASAC)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:VIGIL
Suffix:
Gender:M
Credentials:CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 8TH AVE RM 906
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10018-4190
Mailing Address - Country:US
Mailing Address - Phone:212-679-4960
Mailing Address - Fax:
Practice Address - Street 1:500 8TH AVE RM 906
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10018-4190
Practice Address - Country:US
Practice Address - Phone:212-679-4960
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-27
Last Update Date:2010-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY17584101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY17584OtherCASAC