MEDICARE: VICTORIA LICANDRO

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	1041C0700X	Clinical Social Worker	103339	NY
2	1041C0700X	Clinical Social Worker	TPIC54	FL

General Provider Information

NPI Number	:	1285204354
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICTORIA LICANDRO

Provider Business Mailing Address
First Line	:	26 COURT ST STE 1303
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11242-1113
Country	:	US
Telephone Number	:	347-338-8965
Fax Number	:

Provider Business Practice Location Address
First Line	:	26 COURT ST STE 1303
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11242-1113
Country	:	US
Telephone Number	:	845-709-7390
Fax Number	:

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

Provider Enumeration Date	:	06/30/2021
Last Update Date	:	06/17/2026

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Directions to “ VICTORIA LICANDRO ” Practice Location

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