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General NPI Number Information
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NPI Number | 1902120629
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Entity Type | Individual
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Provider Name | MARISA HELENA VICTORY PSY.D., MA, MSW
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Gender | Female
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Dates
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Enumeration Date | 03/24/2010
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Last Update Date | 12/09/2024
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Provider Practice Location Address
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Address Line | 2100 N MAIN ST STE 304
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City | CROWN POINT
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State | IN
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Zip | 46307-1877
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Country | US
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Telephone | 745-461-9005
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Fax | 574-546-1999
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Provider Business Mailing Address
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Address Line | 5314 LAUREL CREST RUN
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City | NOBLESVILLE
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State | IN
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Zip | 46062-7435
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Country | US
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Telephone | 317-678-0998
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | P.08524
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 39154
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | S.0901121
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License Number State | OH
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Taxonomy #4
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | I.1201235
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License Number State | OH
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Taxonomy #5
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 20043650B
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License Number State | IN
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