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Individual

PEDRO VICENTE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
MSW

Contact information

Practice address
63 GROVE ST, BLOOMFIELD, NJ 07003-5641
(973) 743-2919
Mailing address
45 FAIRMOUNT TER # 1, EAST ORANGE, NJ 07018-2356
(973) 652-8259

Taxonomy

Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
44SW05327400
NJ
104100000X
Social Worker
1041C0700X
Clinical Social Worker
44SW05327400
NJ

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1114219730
NJ
Enumeration date
05/16/2011
Last updated
02/07/2022
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