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General NPI Number Information
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NPI Number | 1336579010
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Entity Type | Organization
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Legal Business Name | JANICE VICTOR
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Dates
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Enumeration Date | 11/18/2013
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Last Update Date | 11/18/2013
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Provider Practice Location Address
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Address Line | 248 LORRAINE AVE SUITE#3
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City | MONTCLAIR
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State | NJ
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Zip | 07043-1454
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Country | US
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Telephone | 862-368-2670
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Fax | 973-744-3550
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Provider Business Mailing Address
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Address Line | 248 LORRAINE AVE SUITE#3
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City | MONTCLAIR
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State | NJ
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Zip | 07043-1454
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Country | US
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Telephone | 862-368-2670
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Fax | 973-744-3550
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Authorized Official
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Title or Position | PROVIDER
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Name | MS. JANICE MARIE VICTOR
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Credential | LCSW
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Telephone | 973-744-3550
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 44SC00148700
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License Number State | NJ
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