Healthcare Provider Details

I. General information

NPI: 1093636136
Provider Name (Legal Business Name): VICTORIA M DEFALCO CHARLAND LCSW
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 N TAMIAMI TRL
NORTH VENICE FL
34275-3667
US

IV. Provider business mailing address

PO BOX 728
NOKOMIS FL
34274-0728
US

V. Phone/Fax

Practice location:
  • Phone: 941-499-1800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: VICTORIA CHARLAND
Title or Position: OWNER/LCSW
Credential: LCSW, CDP
Phone: 941-928-9774