MEDICARE: VICTORIAS ESTATE INC.

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	103TP2701X	Group Psychotherapy Psychologist

General Provider Information

NPI Number	:	1063285682
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VICTORIAS ESTATE INC.

Provider Business Mailing Address
First Line	:	869 TURNPIKE ST UNIT 212
Second Line	:
City	:	NORTH ANDOVER
State	:	MA
Zip	:	01845-6151
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	869 TURNPIKE ST UNIT 212
Second Line	:
City	:	NORTH ANDOVER
State	:	MA
Zip	:	01845-6151
Country	:	US
Telephone Number	:	978-495-1420
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PMHNP
Name	:	CHLOE CAMERON
Credential	:
Telephone Number	:	978-495-1420

Provider Enumeration Date	:	11/06/2023
Last Update Date	:	11/04/2024

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Directions to “VICTORIAS ESTATE INC. ” Practice Location

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