Provider Demographics
NPI:1104194216
Name:VISCUSI, NICOLE M (LMHC)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:M
Last Name:VISCUSI
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:M
Other - Last Name:WITTEMEYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:939 ROUTE 146 STE 610
Mailing Address - Street 2:
Mailing Address - City:CLIFTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12065-3662
Mailing Address - Country:US
Mailing Address - Phone:518-219-8232
Mailing Address - Fax:518-219-0744
Practice Address - Street 1:939 ROUTE 146 STE 610
Practice Address - Street 2:
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065-3662
Practice Address - Country:US
Practice Address - Phone:518-219-8232
Practice Address - Fax:518-219-0744
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-02
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004945101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health