Healthcare Provider Details

I. General information

NPI: 1376090241
Provider Name (Legal Business Name): MARGARET ANNA VISOCSKY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2016
Last Update Date: 09/13/2021
Certification Date: 09/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2420 MARTIN RD STE 200
FAIRFIELD CA
94534-8610
US

IV. Provider business mailing address

2420 MARTIN RD STE 200
FAIRFIELD CA
94534-8610
US

V. Phone/Fax

Practice location:
  • Phone: 707-344-7688
  • Fax:
Mailing address:
  • Phone: 707-399-4520
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number104919
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number127924
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: