MEDICARE: MR. VIINCENT R COLUCCIO LCSW

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	R03820-1	NY

General Provider Information

NPI Number	:	1851444723
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. VIINCENT R COLUCCIO LCSW

Provider Business Mailing Address
First Line	:	75 DELLWOOD CT
Second Line	:
City	:	WESTTOWN
State	:	NY
Zip	:	10998-3805
Country	:	US
Telephone Number	:	845-683-1131
Fax Number	:

Provider Business Practice Location Address
First Line	:	22 NORTH RD.
Second Line	:
City	:	BLOOMBURG
State	:	NY
Zip	:	12721-4654
Country	:	US
Telephone Number	:	845-733-5626
Fax Number	:

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

Provider Enumeration Date	:	01/22/2007
Last Update Date	:	07/08/2007

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