MEDICARE: JESSICA VISCOMI LMFT

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	251S00000X	Community/Behavioral Health Agency	104851	CA
2	390200000X	Student in an Organized Health Care Education/Training Program	IMF68800	CA
3	106H00000X	Marriage & Family Therapist	104851	CA

General Provider Information

NPI Number	:	1992181168
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA VISCOMI LMFT

Provider Business Mailing Address
First Line	:	PO BOX 590862
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94159-0862
Country	:	US
Telephone Number	:	415-409-9591
Fax Number	:

Provider Business Practice Location Address
First Line	:	3516 GEARY BLVD STE 102
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94118-3213
Country	:	US
Telephone Number	:	415-569-0239
Fax Number	:

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

Provider Enumeration Date	:	08/10/2015
Last Update Date	:	10/29/2022

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