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General NPI Number Information
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NPI Number | 1205553252
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Entity Type | Individual
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Provider Name | MICHAEL B VICTOR DNP
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Gender | Male
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Dates
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Enumeration Date | 10/20/2022
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Last Update Date | 09/13/2024
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Provider Practice Location Address
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Address Line | 430 NEW PARK AVE STE 102
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City | WEST HARTFORD
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State | CT
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Zip | 06110-1142
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Country | US
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Telephone | 844-830-7233
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Fax |
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Provider Business Mailing Address
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Address Line | 430 NEW PARK AVE STE 102
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City | WEST HARTFORD
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State | CT
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Zip | 06110-1142
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Country | US
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Telephone | 844-830-7233
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | APN.0999111-NP
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 12125
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License Number State | CT
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | F404552
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License Number State | NY
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