Provider Demographics
NPI:1336458736
Name:VISCONTI, STEPHANIE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:
Last Name:VISCONTI
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 1:635 JAMES ST
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13203-2226
Mailing Address - Country:US
Mailing Address - Phone:315-472-3171
Mailing Address - Fax:
Practice Address - Street 1:635 JAMES ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13203-2226
Practice Address - Country:US
Practice Address - Phone:315-472-3171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-02
Last Update Date:2013-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0804971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical