Provider Demographics
NPI:1235221920
Name:INCRIVAGLIA, VICTORIA MARY (LCSW)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:MARY
Last Name:INCRIVAGLIA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 E SUNSHINE ST
Mailing Address - Street 2:STE 201
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-1819
Mailing Address - Country:US
Mailing Address - Phone:417-823-0498
Mailing Address - Fax:417-889-5289
Practice Address - Street 1:2200 E SUNSHINE ST
Practice Address - Street 2:STE 201
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-1819
Practice Address - Country:US
Practice Address - Phone:417-823-0498
Practice Address - Fax:417-889-5289
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2008-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOSW002668251K00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251K00000XAgenciesPublic Health or Welfare