Provider Demographics
NPI:1235305210
Name:CAROLYN I VICCHIULLO PSYD
Entity type:Organization
Organization Name:CAROLYN I VICCHIULLO PSYD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:IRMA
Authorized Official - Last Name:VICCHIULLO
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:610-253-8900
Mailing Address - Street 1:2030 LEHIGH ST
Mailing Address - Street 2:SUITE 107
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18042-3853
Mailing Address - Country:US
Mailing Address - Phone:610-253-8900
Mailing Address - Fax:610-253-7062
Practice Address - Street 1:2030 LEHIGH ST
Practice Address - Street 2:SUITE 107
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18042-3853
Practice Address - Country:US
Practice Address - Phone:610-253-8900
Practice Address - Fax:610-253-7062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-30
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS015116103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1765117OtherHIGHMARK
03183600OtherCBC
PA262019000OtherMAGELLAN
03183600OtherCBC
PA262019000OtherMAGELLAN