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General NPI Number Information
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NPI Number | 1538607171
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Entity Type | Organization
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Legal Business Name | CAROL A VISCONTI, LLC
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Dates
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Enumeration Date | 02/02/2017
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Last Update Date | 02/02/2017
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Provider Practice Location Address
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Address Line | 2285 MARSH HAWK LN APT 3-302
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City | FLEMING ISLAND
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State | FL
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Zip | 32003-6363
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Country | US
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Telephone | 856-982-8601
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Fax |
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Provider Business Mailing Address
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Address Line | 2285 MARSH HAWK LN APT 3-302
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City | FLEMING ISLAND
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State | FL
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Zip | 32003-6363
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Country | US
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Telephone | 856-982-8601
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Fax |
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Authorized Official
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Title or Position | OWNER/OPERATOR
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Name | CAROL A VISCONTI
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Credential |
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Telephone | 856-982-8601
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number |
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License Number State |
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