1639220387 NPI number — MR. LOUIS VINCENT VISCOSI III MS LPC

Table of content: MR. LOUIS VINCENT VISCOSI III MS LPC (NPI 1639220387)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639220387 NPI number — MR. LOUIS VINCENT VISCOSI III MS LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VISCOSI
Provider First Name:
LOUIS
Provider Middle Name:
VINCENT
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
III
Provider Credential Text:
MS LPC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1639220387
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/24/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
141 E MAIN ST
Provider Second Line Business Mailing Address:
4TH FLOOR ADMINISTRATION
Provider Business Mailing Address City Name:
WATERBURY
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06702-2310
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-574-9000
Provider Business Mailing Address Fax Number:
203-574-9006

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
141 E MAIN ST
Provider Second Line Business Practice Location Address:
WATERBURY CLINICAL SERVICES 2ND FLOOR
Provider Business Practice Location Address City Name:
WATERBURY
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06702-2310
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-756-7387
Provider Business Practice Location Address Fax Number:
203-596-0722
Provider Enumeration Date:
01/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  0004655 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 004254885 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 347109 . This is a "MHN MANAGED HEALTH NETWORK" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: D339209 . This is a "VALUE OPTIONS/BEACON HEALTH STRATEGIES" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: PENDING . This is a "AETNA BEHAVIORAL HEALTH" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 11341132 . This is a "CAQH" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 060669107 . This is a "UNITED BEHAVIORAL HEALTH - WELLMORE GRP/FACILITY" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 060669107 . This is a "UBH-OXFORD HEALTH FREEDOM/LIBERTY WELLMORE, INC." identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 347109 . This is a "MHN TRICARE NORTH" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 060669107 . This is a "ANTHEM BCBS OF CT WELLMORE GRP/FACILITY" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 060669107 . This is a "UBH-UNITED HEALTHCARE WELLMORE FACILITY/GRP" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: PENDING . This is a "CIGNA BEHAVIORAL HEALTH" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 060669107 . This is a "HEALTHYCT WELLMORE GRP/FACILITY" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 060669107 . This is a "UBH- CONNECTICARE WELLMORE GRP/FACILTY" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




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