MEDICARE: MRS. VICTORIA K KIJANSKI LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	SW6440	FL

General Provider Information

NPI Number	:	1417059668
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. VICTORIA K KIJANSKI LCSW

Provider Business Mailing Address
First Line	:	205 S MACDILL AVE
Second Line	:	SUITE A
City	:	TAMPA
State	:	FL
Zip	:	33609-3130
Country	:	US
Telephone Number	:	813-767-7426
Fax Number	:	813-531-6563

Provider Business Practice Location Address
First Line	:	205 S MACDILL AVE
Second Line	:	SUITE A
City	:	TAMPA
State	:	FL
Zip	:	33609-3130
Country	:	US
Telephone Number	:	813-767-7426
Fax Number	:	813-531-6563

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/01/2006
Last Update Date	:	06/10/2008

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