Provider Demographics
NPI:1487244398
Name:CIOCCA VASINO, MARTIN
Entity type:Individual
Prefix:
First Name:MARTIN
Middle Name:
Last Name:CIOCCA VASINO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1202 COPPER STONE CT
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-8235
Mailing Address - Country:US
Mailing Address - Phone:971-864-0557
Mailing Address - Fax:
Practice Address - Street 1:450 OAKMEARS CRES APT 203
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23464-5470
Practice Address - Country:US
Practice Address - Phone:971-864-0557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-25
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC5996101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health