Healthcare Provider Details

I. General information

NPI: 1841640984
Provider Name (Legal Business Name): AUTUMN VINCIQUERRA LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2016
Last Update Date: 08/25/2025
Certification Date: 08/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5800 GLENWOOD AVE
MAPLE HEIGHTS OH
44137-3700
US

IV. Provider business mailing address

1801 ROCKEFELLER RD
WICKLIFFE OH
44092-1939
US

V. Phone/Fax

Practice location:
  • Phone: 216-438-6020
  • Fax:
Mailing address:
  • Phone: 440-231-1994
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: