Healthcare Provider Details

I. General information

NPI: 1801869102
Provider Name (Legal Business Name): VICTORIA S MASIH LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2006
Last Update Date: 03/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 COCHRANE CIRCLE, BUILDING 7500 EVANS ARMY COMMUNITY HOPSITAL
FORT CARSON CO
80913
US

IV. Provider business mailing address

4420 LAREDO MEADOW PT APARTMENT 208
COLORADO SPRINGS CO
80922-4002
US

V. Phone/Fax

Practice location:
  • Phone: 719-526-7399
  • Fax:
Mailing address:
  • Phone: 719-380-0813
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number37751
License Number StateTX

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: