Provider Demographics
NPI:1831773373
Name:DIDONATO, VIRGINIA H (MA, BCC)
Entity type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:H
Last Name:DIDONATO
Suffix:
Gender:F
Credentials:MA, BCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2358 24TH ST
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11105-3415
Mailing Address - Country:US
Mailing Address - Phone:646-729-8803
Mailing Address - Fax:
Practice Address - Street 1:2358 24TH ST
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11105-3415
Practice Address - Country:US
Practice Address - Phone:646-729-8803
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-11
Last Update Date:2022-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYBCC3637171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach