Individual
EILEEN VICKERY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
396 BROADWAY, MONTICELLO, NY 12701-1157
(845) 794-8080
Mailing address
PO BOX 25, 30 SPRUCE STREET WEST, WURTSBORO, NY 12790-0025
(845) 800-7465
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
29481
NY
Other
Enumeration date
05/11/2015
Last updated
05/11/2015
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