Provider Demographics
NPI:1609803915
Name:VITTICORE, MARY A (NP)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:A
Last Name:VITTICORE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 SHIRLEY ST
Mailing Address - Street 2:
Mailing Address - City:SHORTSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14548-9327
Mailing Address - Country:US
Mailing Address - Phone:585-232-5040
Mailing Address - Fax:585-232-5072
Practice Address - Street 1:1867 MOUNT HOPE AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14620-4540
Practice Address - Country:US
Practice Address - Phone:585-232-5040
Practice Address - Fax:585-232-5040
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF400628-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health