Provider Demographics
NPI:1912217233
Name:VISCOSI, MARCELLA P (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MARCELLA
Middle Name:P
Last Name:VISCOSI
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 1:110 NORTH COUNTRY ROAD
Mailing Address - Street 2:
Mailing Address - City:MOUNT SINAI
Mailing Address - State:NY
Mailing Address - Zip Code:11766-1525
Mailing Address - Country:US
Mailing Address - Phone:631-870-2612
Mailing Address - Fax:631-870-2625
Practice Address - Street 1:110 NORTH COUNTRY ROAD
Practice Address - Street 2:
Practice Address - City:MOUNT SINAI
Practice Address - State:NY
Practice Address - Zip Code:11766-1525
Practice Address - Country:US
Practice Address - Phone:631-870-2612
Practice Address - Fax:631-870-2625
Is Sole Proprietor?:No
Enumeration Date:2010-10-20
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0432281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01379982Medicaid