Healthcare Provider Details

I. General information

NPI: 1821437385
Provider Name (Legal Business Name): VICTORIA V AMERSON LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2013
Last Update Date: 06/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5901 E 7TH ST
LONG BEACH CA
90822-5201
US

IV. Provider business mailing address

420 W 5TH AVE
FLINT MI
48503-2445
US

V. Phone/Fax

Practice location:
  • Phone: 562-480-0720
  • Fax: 562-826-5270
Mailing address:
  • Phone: 810-496-4915
  • Fax: 810-496-4922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801087960
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: