Provider Demographics
NPI:1992181168
Name:VISCOMI, JESSICA (LMFT)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:VISCOMI
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:CHIARA
Other - Middle Name:
Other - Last Name:VISCOMI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMFT
Mailing Address - Street 1:PO BOX 590862
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94159-0862
Mailing Address - Country:US
Mailing Address - Phone:415-409-9591
Mailing Address - Fax:
Practice Address - Street 1:3516 GEARY BLVD STE 102
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94118-3213
Practice Address - Country:US
Practice Address - Phone:415-569-0239
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-10
Last Update Date:2022-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA104851251S00000X, 106H00000X
CAIMF68800390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No251S00000XAgenciesCommunity/Behavioral Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program