Healthcare Provider Details

I. General information

NPI: 1700120797
Provider Name (Legal Business Name): VICTORIA CAIN LCSW, CT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2012
Last Update Date: 08/06/2024
Certification Date: 08/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 GEORGIA ST NE STE A4
ALBUQUERQUE NM
87110-1391
US

IV. Provider business mailing address

7850 JEFFERSON ST NE STE 300
ALBUQUERQUE NM
87109-4314
US

V. Phone/Fax

Practice location:
  • Phone: 505-891-1583
  • Fax:
Mailing address:
  • Phone: 505-884-1114
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC-09477
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: