Healthcare Provider Details

I. General information

NPI: 1518237205
Provider Name (Legal Business Name): VANESSA LYNN VICTOR LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: VANESSA LYNN HAYWOOD LICSW

II. Dates (important events)

Enumeration Date: 01/11/2012
Last Update Date: 02/10/2025
Certification Date: 02/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 1ST ST NE FL 10
WASHINGTON DC
20002-7954
US

IV. Provider business mailing address

1101 CONNECTICUT AVE NW
WASHINGTON DC
20036-4303
US

V. Phone/Fax

Practice location:
  • Phone: 202-573-6585
  • Fax:
Mailing address:
  • Phone: 323-509-6115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberASW31416
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateDC
# 3
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License NumberLC50080447
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: