Provider Demographics
NPI:1306974605
Name:VAUGHAN, JAMES ANTONIO (LCSW)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:ANTONIO
Last Name:VAUGHAN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1901 MADISON AVE APT 330
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10035-2730
Mailing Address - Country:US
Mailing Address - Phone:212-426-7494
Mailing Address - Fax:212-426-2447
Practice Address - Street 1:19 W 34TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-3006
Practice Address - Country:US
Practice Address - Phone:917-873-7170
Practice Address - Fax:212-426-2447
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY076483-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical