Provider Demographics
NPI:1467848648
Name:VIGIL, JUAN L (LCSW)
Entity type:Individual
Prefix:MR
First Name:JUAN
Middle Name:L
Last Name:VIGIL
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2224 ABEY BLANCO DR
Mailing Address - Street 2:SUITE E
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-7381
Mailing Address - Country:US
Mailing Address - Phone:407-823-8421
Mailing Address - Fax:407-482-2389
Practice Address - Street 1:201 RUBY AVE
Practice Address - Street 2:SUITE A
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34747
Practice Address - Country:US
Practice Address - Phone:407-933-1847
Practice Address - Fax:407-933-1849
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-14
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW122281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical