Healthcare Provider Details

I. General information

NPI: 1881469922
Provider Name (Legal Business Name): VICTORIA PRISCO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2023
Last Update Date: 12/04/2023
Certification Date: 12/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

929 LOMBARD ST APT 105
PHILADELPHIA PA
19147-1264
US

IV. Provider business mailing address

929 LOMBARD ST APT 105
PHILADELPHIA PA
19147-1264
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 TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: VICTORIA J PRISCO
Title or Position: CEO
Credential: LPC
Phone: 215-280-4090