Individual
DONNA R VICKERY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
19 PROSPECT ST, SUMMIT, NJ 07901-2530
(330) 758-4515
(330) 758-5121
Mailing address
19 PROSPECT ST, SUMMIT, NJ 07901-2530
(330) 758-4515
(330) 758-5121
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
25MA05262400
NJ
Other
Enumeration date
06/11/2006
Last updated
03/31/2009
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