MEDICARE: DR. VICTORIA MARUCA HAVRON PSYD

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	103T00000X	Psychologist	242770	KY

General Provider Information

NPI Number	:	1083083414
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VICTORIA MARUCA HAVRON PSYD

Provider Business Mailing Address
First Line	:	130 DUDLEY PIKE STE 195
Second Line	:
City	:	EDGEWOOD
State	:	KY
Zip	:	41017-2502
Country	:	US
Telephone Number	:	859-910-0988
Fax Number	:

Provider Business Practice Location Address
First Line	:	130 DUDLEY PIKE STE 195
Second Line	:
City	:	EDGEWOOD
State	:	KY
Zip	:	41017-2502
Country	:	US
Telephone Number	:	859-910-0988
Fax Number	:	859-910-0988

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/16/2015
Last Update Date	:	12/10/2023

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