MEDICARE: MR. LOUIS VINCENT VISCOSI III MS LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	0004655	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	347109	OTHER	CT	MHN MANAGED HEALTH NETWORK
3	D339209	OTHER	CT	VALUE OPTIONS/BEACON HEALTH STRATEGIES
4	PENDING	OTHER	CT	AETNA BEHAVIORAL HEALTH
5	11341132	OTHER	CT	CAQH
6	060669107	OTHER	CT	UNITED BEHAVIORAL HEALTH - WELLMORE GRP/FACILITY
7	060669107	OTHER	CT	UBH-OXFORD HEALTH FREEDOM/LIBERTY WELLMORE, INC.
8	347109	OTHER	CT	MHN TRICARE NORTH
9	060669107	OTHER	CT	ANTHEM BCBS OF CT WELLMORE GRP/FACILITY
10	060669107	OTHER	CT	UBH-UNITED HEALTHCARE WELLMORE FACILITY/GRP
11	PENDING	OTHER	CT	CIGNA BEHAVIORAL HEALTH
12	060669107	OTHER	CT	HEALTHYCT WELLMORE GRP/FACILITY
13	060669107	OTHER	CT	UBH- CONNECTICARE WELLMORE GRP/FACILTY

General Provider Information

NPI Number	:	1639220387
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. LOUIS VINCENT VISCOSI III MS LPC

Provider Business Mailing Address
First Line	:	141 E MAIN ST
Second Line	:	4TH FLOOR ADMINISTRATION
City	:	WATERBURY
State	:	CT
Zip	:	06702-2310
Country	:	US
Telephone Number	:	203-574-9000
Fax Number	:	203-574-9006

Provider Business Practice Location Address
First Line	:	141 E MAIN ST
Second Line	:	WATERBURY CLINICAL SERVICES 2ND FLOOR
City	:	WATERBURY
State	:	CT
Zip	:	06702-2310
Country	:	US
Telephone Number	:	203-756-7387
Fax Number	:	203-596-0722

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/16/2007
Last Update Date	:	12/24/2015

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