MEDICARE: AUTUMN VINCIQUERRA LPCC

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	101YM0800X	Mental Health Counselor

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

General Provider Information

NPI Number	:	1841640984
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AUTUMN VINCIQUERRA LPCC

Provider Business Mailing Address
First Line	:	1801 ROCKEFELLER RD
Second Line	:
City	:	WICKLIFFE
State	:	OH
Zip	:	44092-1939
Country	:	US
Telephone Number	:	440-231-1994
Fax Number	:

Provider Business Practice Location Address
First Line	:	5800 GLENWOOD AVE
Second Line	:
City	:	MAPLE HEIGHTS
State	:	OH
Zip	:	44137-3700
Country	:	US
Telephone Number	:	216-438-6020
Fax Number	:

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

Provider Enumeration Date	:	06/20/2016
Last Update Date	:	08/25/2025

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