Healthcare Provider Details

I. General information

NPI: 1093022170
Provider Name (Legal Business Name): VICTORIA JEAN PRISCO ATR, LCAT, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2010
Last Update Date: 12/04/2023
Certification Date: 12/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

929 LOMBARD ST
PHILADELPHIA PA
19147-1260
US

IV. Provider business mailing address

929 LOMBARD ST
PHILADELPHIA PA
19147-1260
US

V. Phone/Fax

Practice location:
  • Phone: 215-280-4090
  • Fax:
Mailing address:
  • Phone: 215-280-4090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberPC010104
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number001276
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC010104
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: