Provider Demographics
NPI:1902875008
Name:HARWOOD, VICTORIA ANN (LCSW, CAP)
Entity Type:Individual
Prefix:MS
First Name:VICTORIA
Middle Name:ANN
Last Name:HARWOOD
Suffix:
Gender:F
Credentials:LCSW, CAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:438 MYRTLEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-7734
Mailing Address - Country:US
Mailing Address - Phone:321-409-9191
Mailing Address - Fax:321-409-9191
Practice Address - Street 1:1900 S HARBOR CITY BLVD
Practice Address - Street 2:STE 216
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-4749
Practice Address - Country:US
Practice Address - Phone:321-409-9191
Practice Address - Fax:321-409-9191
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2010-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW00028561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU04762015OtherCIGNA PROVIDER #
FL070354OtherVALUE OPTIONS PROVIDER #
FL255651000OtherMBHC MIS#
FLZ0039Medicare ID - Type Unspecified