Provider Demographics
NPI:1134344013
Name:VISOSKY, TASHA R (LMSW)
Entity type:Individual
Prefix:
First Name:TASHA
Middle Name:R
Last Name:VISOSKY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:TASHA
Other - Middle Name:RAE
Other - Last Name:BRADIGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2 ACADEMY STREET
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MAYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14757
Mailing Address - Country:US
Mailing Address - Phone:716-753-4554
Mailing Address - Fax:716-753-4230
Practice Address - Street 1:200 E 3RD ST STE 5
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:NY
Practice Address - Zip Code:14701-5433
Practice Address - Country:US
Practice Address - Phone:716-661-8330
Practice Address - Fax:716-753-4230
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0928351041C0700X, 1041C0700X
NY076950-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker