Provider Demographics
NPI:1568501773
Name:VIGNOLA, DONNA A (LCSW - R)
Entity type:Individual
Prefix:MS
First Name:DONNA
Middle Name:A
Last Name:VIGNOLA
Suffix:
Gender:F
Credentials:LCSW - R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:819 MONROE ST
Mailing Address - Street 2:
Mailing Address - City:WEST HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11552-3820
Mailing Address - Country:US
Mailing Address - Phone:516-486-8285
Mailing Address - Fax:
Practice Address - Street 1:115 E BETHPAGE RD
Practice Address - Street 2:
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803-4221
Practice Address - Country:US
Practice Address - Phone:516-293-2016
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR023706-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01476806Medicaid
NYW8D361Medicare ID - Type Unspecified