Healthcare Provider Details

I. General information

NPI: 1073690608
Provider Name (Legal Business Name): VICTORIA M MCCAIN PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: VICTORIA J MCCAIN PHD

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1516 COOPER ST
FORT WORTH TX
76104-2710
US

IV. Provider business mailing address

801 7TH AVE REVENUE MANAGEMENT
FORT WORTH TX
76104-2733
US

V. Phone/Fax

Practice location:
  • Phone: 682-885-1480
  • Fax: 682-885-3600
Mailing address:
  • Phone: 682-885-4157
  • Fax: 682-885-1903

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number30569
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number30569
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: