Provider Demographics
NPI:1699822684
Name:VISCONTI, PATRICIA A (MA, LMHC)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:A
Last Name:VISCONTI
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:463 MAPLE AVE
Mailing Address - Street 2:APT 3
Mailing Address - City:ELMIRA
Mailing Address - State:NY
Mailing Address - Zip Code:14904-1450
Mailing Address - Country:US
Mailing Address - Phone:607-725-0129
Mailing Address - Fax:
Practice Address - Street 1:416 E.AST 14TH STREET
Practice Address - Street 2:
Practice Address - City:ELMIRA HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:14903
Practice Address - Country:US
Practice Address - Phone:607-725-0129
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001302101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health