Healthcare Provider Details

I. General information

NPI: 1245809318
Provider Name (Legal Business Name): VICTORIA ANN BOATWRIGHT LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2021
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2204 MORRIS AVE STE 308
UNION NJ
07083-5914
US

IV. Provider business mailing address

786 MOUNTAIN BLVD STE 104
WATCHUNG NJ
07069-6268
US

V. Phone/Fax

Practice location:
  • Phone: 908-322-9623
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SL06436500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: