Provider Demographics
NPI:1437412939
Name:VIGILANTE DILORENZO, DARLA JEAN (PSYD, BCBA)
Entity type:Individual
Prefix:DR
First Name:DARLA
Middle Name:JEAN
Last Name:VIGILANTE DILORENZO
Suffix:
Gender:F
Credentials:PSYD, BCBA
Other - Prefix:MS
Other - First Name:DARLA
Other - Middle Name:JEAN
Other - Last Name:VIGILANTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 2256
Mailing Address - Street 2:
Mailing Address - City:HALESITE
Mailing Address - State:NY
Mailing Address - Zip Code:11743-0889
Mailing Address - Country:US
Mailing Address - Phone:347-416-0605
Mailing Address - Fax:
Practice Address - Street 1:935 NORTHERN BLVD
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-5316
Practice Address - Country:US
Practice Address - Phone:516-487-7116
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-19
Last Update Date:2025-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1-20-41122103K00000X
NY1124468103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst