Benedict Vicarisi Jr Jr., ED.S

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

PC01046 Issued in NJ

Practice address

395 Pleasant Valley Way
West Orange, NJ 07052-2905

Phone

(973) 495-1818

Fax

(973) 495-1818

NPI assigned

Sep 20, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1732233600000",
    "number": "1144328931",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "69 HAZEL AVENUE",
            "city": "WEST ORANGE",
            "state": "NJ",
            "postal_code": "070524524",
            "telephone_number": "973-495-1818"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "395 PLEASANT VALLEY WAY",
            "city": "WEST ORANGE",
            "state": "NJ",
            "postal_code": "070522905",
            "telephone_number": "973-495-1818",
            "fax_number": "973-495-1818"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VICARISI JR",
        "first_name": "BENEDICT",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "ED.S",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-20",
        "last_updated": "2024-11-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "NJ",
            "license": "PC01046",
            "primary": true
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "NJ",
            "license": "FI0014959",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH NET MANAGED CARE",
            "identifier": "232752",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MAGELLAN BLUE CROSS",
            "identifier": "490655000",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OXFORD",
            "identifier": "P2728931",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Professional Counselor in West Orange, NJ
• Providers in West Orange, NJ by specialty
• Professional Counselor in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.