Individual
MR. JOHN P VICEDOMINI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
1286 SHAW PL, SEAFORD, NY 11783-1747
(516) 221-2032
Mailing address
1286 SHAW PL, SEAFORD, NY 11783-1747
(516) 221-2032
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
0129651
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01767748
—
NY
Enumeration date
12/19/2005
Last updated
09/09/2011
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