Provider Demographics
NPI:1447312111
Name:VIGILANTI, MARY ANN (EDD)
Entity type:Individual
Prefix:DR
First Name:MARY ANN
Middle Name:
Last Name:VIGILANTI
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6216 LAIRD AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94605-1723
Mailing Address - Country:US
Mailing Address - Phone:510-632-6619
Mailing Address - Fax:
Practice Address - Street 1:1345 B ST
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94541-2917
Practice Address - Country:US
Practice Address - Phone:510-635-1588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 8374103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist