Provider Demographics
NPI:1336369040
Name:VISCUSI, ATHENA (LICSW)
Entity Type:Individual
Prefix:MS
First Name:ATHENA
Middle Name:
Last Name:VISCUSI
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1708 LAMONT ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20010-2632
Mailing Address - Country:US
Mailing Address - Phone:202-320-5738
Mailing Address - Fax:
Practice Address - Street 1:1628 11TH ST NW
Practice Address - Street 2:LYLE HEALTHCARE
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20001-5011
Practice Address - Country:US
Practice Address - Phone:202-232-4270
Practice Address - Fax:202-232-4394
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2014-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC3022571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical