Provider Demographics
NPI:1043593601
Name:VISCO, ANTHONY AUGUST (LMSW)
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:AUGUST
Last Name:VISCO
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 CENTER RD
Mailing Address - Street 2:
Mailing Address - City:EAST AURORA
Mailing Address - State:NY
Mailing Address - Zip Code:14052-3009
Mailing Address - Country:US
Mailing Address - Phone:716-652-8250
Mailing Address - Fax:716-655-3675
Practice Address - Street 1:1010 CENTER RD
Practice Address - Street 2:
Practice Address - City:EAST AURORA
Practice Address - State:NY
Practice Address - Zip Code:14052-3009
Practice Address - Country:US
Practice Address - Phone:716-652-8250
Practice Address - Fax:716-655-3675
Is Sole Proprietor?:No
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0569581041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool