Individual
CAROLYN IRMA VICCHIULLO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSYD
Contact information
Practice address
2030 LEHIGH ST, SUITE 107, EASTON, PA 18042
(610) 253-8900
(610) 253-7062
Mailing address
2725 UPSTREAM FARM RD, EASTON, PA 18040
(610) 248-1797
(610) 253-7062
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PS015116
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
03183600
CBC
PA
01
—
262019000
MAGELLAN
PA
Enumeration date
02/09/2006
Last updated
04/02/2024
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