Healthcare Provider Details

I. General information

NPI: 1407355779
Provider Name (Legal Business Name): VICTORIA SHIN LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2018
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4514 251ST ST STE 105A
LITTLE NECK NY
11362-1327
US

IV. Provider business mailing address

4514 251ST ST STE 105A
LITTLE NECK NY
11362-1327
US

V. Phone/Fax

Practice location:
  • Phone: 347-745-8195
  • Fax:
Mailing address:
  • Phone: 347-745-8195
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number010269
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: