Provider Demographics
NPI:1780358937
Name:VIZCARRONDO, JUDITH (LCSW)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:
Last Name:VIZCARRONDO
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 1:873 US ROUTE 1 # 6262
Mailing Address - Street 2:
Mailing Address - City:NORTH BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08902-3345
Mailing Address - Country:US
Mailing Address - Phone:856-267-3205
Mailing Address - Fax:
Practice Address - Street 1:100 SOMERSET CORPORATE BLVD FL 2
Practice Address - Street 2:
Practice Address - City:BRIDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:08807-2842
Practice Address - Country:US
Practice Address - Phone:856-267-3205
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-02
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC059877001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical