Provider Demographics
NPI:1770779944
Name:VICALEX BEHAVIORAL HEALTH LCSW SERVICES, P.C.
Entity type:Organization
Organization Name:VICALEX BEHAVIORAL HEALTH LCSW SERVICES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CLAUDIA
Authorized Official - Middle Name:J
Authorized Official - Last Name:OLAVE-GUILLERMO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-364-9226
Mailing Address - Street 1:978 ROUTE 45
Mailing Address - Street 2:STE 200
Mailing Address - City:POMONA
Mailing Address - State:NY
Mailing Address - Zip Code:10970-3521
Mailing Address - Country:US
Mailing Address - Phone:845-364-9226
Mailing Address - Fax:
Practice Address - Street 1:978 ROUTE 45
Practice Address - Street 2:STE 200
Practice Address - City:POMONA
Practice Address - State:NY
Practice Address - Zip Code:10970-3521
Practice Address - Country:US
Practice Address - Phone:845-364-9226
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-20
Last Update Date:2014-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY071579-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYNN8451Medicare PIN