Healthcare Provider Details

I. General information

NPI: 1124003447
Provider Name (Legal Business Name): JANICE MARIE VICTOR LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2005
Last Update Date: 08/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 MAGNOLIA LN
CALDWELL NJ
07006-5554
US

IV. Provider business mailing address

24 MAGNOLIA LN
CALDWELL NJ
07006-5554
US

V. Phone/Fax

Practice location:
  • Phone: 973-226-7662
  • Fax: 973-226-7776
Mailing address:
  • Phone: 973-226-7662
  • Fax: 973-226-7776

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC00148700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: