Provider Demographics
NPI:1992451157
Name:VISCIDY, MICHAEL RICHARD-HARDIN (MSW, LSW)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:RICHARD-HARDIN
Last Name:VISCIDY
Suffix:
Gender:M
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:337 WINDSOR CT
Mailing Address - Street 2:
Mailing Address - City:EWING
Mailing Address - State:NJ
Mailing Address - Zip Code:08638-1845
Mailing Address - Country:US
Mailing Address - Phone:856-341-3084
Mailing Address - Fax:
Practice Address - Street 1:337 WINDSOR CT
Practice Address - Street 2:
Practice Address - City:EWING
Practice Address - State:NJ
Practice Address - Zip Code:08638-1845
Practice Address - Country:US
Practice Address - Phone:856-341-3084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-25
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL06767100104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker