Provider Demographics
NPI:1851444723
Name:COLUCCIO, VIINCENT R (LCSW)
Entity Type:Individual
Prefix:MR
First Name:VIINCENT
Middle Name:R
Last Name:COLUCCIO
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 DELLWOOD CT
Mailing Address - Street 2:
Mailing Address - City:WESTTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10998-3805
Mailing Address - Country:US
Mailing Address - Phone:845-683-1131
Mailing Address - Fax:
Practice Address - Street 1:22 NORTH RD.
Practice Address - Street 2:
Practice Address - City:BLOOMBURG
Practice Address - State:NY
Practice Address - Zip Code:12721-4654
Practice Address - Country:US
Practice Address - Phone:845-733-5626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR03820-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health