Provider Demographics
NPI:1548399215
Name:ACQUAFREDDA ASSUMMA, VICTORIA T (LCSW-R)
Entity Type:Individual
Prefix:MS
First Name:VICTORIA
Middle Name:T
Last Name:ACQUAFREDDA ASSUMMA
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 DAY RD
Mailing Address - Street 2:
Mailing Address - City:ARMONK
Mailing Address - State:NY
Mailing Address - Zip Code:10504-2408
Mailing Address - Country:US
Mailing Address - Phone:914-273-5819
Mailing Address - Fax:
Practice Address - Street 1:22 DAY RD
Practice Address - Street 2:
Practice Address - City:ARMONK
Practice Address - State:NY
Practice Address - Zip Code:10504-2408
Practice Address - Country:US
Practice Address - Phone:914-273-5819
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR016146-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
195542OtherMENTAL HEALTH NETWORK
195542OtherUNITED BEHAVORIAL HEALTH
N9A721Medicare ID - Type Unspecified