Provider Demographics
NPI:1972383859
Name:VICENTE, ALIDIS (LCSW)
Entity Type:Individual
Prefix:
First Name:ALIDIS
Middle Name:
Last Name:VICENTE
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 1:26 GARDEN OVAL
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07081-1804
Mailing Address - Country:US
Mailing Address - Phone:201-407-0651
Mailing Address - Fax:
Practice Address - Street 1:26 GARDEN OVAL
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07081-1804
Practice Address - Country:US
Practice Address - Phone:201-407-0651
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-29
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC062258001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical