Individual
LAURA NICOLL VICIOSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
110 CHURCH ST, PHILADELPHIA, PA 19106-2201
(267) 807-0550
Mailing address
5244 N 6TH ST, PHILADELPHIA, PA 19120-3119
(267) 778-7144
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
07/25/2023
Last updated
07/25/2023
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