MEDICARE: VICTORIA FLEMING LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0850X	Adult Mental Health Clinic/Center
2	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1053015297
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VICTORIA FLEMING LLC

Provider Business Mailing Address
First Line	:	PO BOX 3080
Second Line	:
City	:	NEWPORT
State	:	RI
Zip	:	02840-0319
Country	:	US
Telephone Number	:	847-412-8000
Fax Number	:

Provider Business Practice Location Address
First Line	:	360 BROADWAY
Second Line	:
City	:	NEWPORT
State	:	RI
Zip	:	02840-1735
Country	:	US
Telephone Number	:	860-999-1257
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	DR. VICTORIA MANION FLEMING
Credential	:	PHD, LCPC
Telephone Number	:	847-412-8000

Provider Enumeration Date	:	03/30/2023
Last Update Date	:	03/30/2023

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