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General NPI Number Information
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NPI Number | 1508458944
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Entity Type | Individual
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Provider Name | ERIC TIMOTHY VICTORINO LMHC, LPC
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Gender | Male
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Dates
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Enumeration Date | 02/08/2021
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Last Update Date | 03/11/2025
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Provider Practice Location Address
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Address Line | 1222 ARSENAL ST
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City | WATERTOWN
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State | NY
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Zip | 13601-2297
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Country | US
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Telephone | 315-425-4400
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Fax |
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Provider Business Mailing Address
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Address Line | 12868 HOUSE RD
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City | CLAYTON
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State | NY
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Zip | 13624-3173
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Country | US
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Telephone | 315-955-9583
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 006747
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 013778-01
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License Number State | NY
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