Doctor Name: | VICTORIA MARY INCRIVAGLIA |
NPI Number: | 1235221920 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | L.C.S.W. |
License Number: | SW002668 |
Business Practice Address: | 2200 E Sunshine St Ste 201 Springfield, MO - 658041819 |
Business Phone Number: | 4178230498 |
Business Fax Number: | 4178895289 |
Mailing Address: | 2200 E Sunshine St, Ste 201 SPRINGFIELD |
State: | MO |
Postal Code: | 658041819 |
Phone Number: | 4178230498 |
Fax Number: | 4178895289 |
NPI Enumeration Date: | 09/29/2006 |
NPI Last Update Date: | 01/02/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 251K00000X |
License Number: | SW002668 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | MO |
Taxonomy Type: | Agencies |
Taxonomy Classification: | Public Health or Welfare |
Taxonomy Specialization: | |
Taxonomy Definition: |