Provider Demographics
NPI:1700120797
Name:CAIN, VICTORIA (LCSW, CT)
Entity type:Individual
Prefix:MRS
First Name:VICTORIA
Middle Name:
Last Name:CAIN
Suffix:
Gender:F
Credentials:LCSW, CT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7850 JEFFERSON ST NE STE 300
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-4314
Mailing Address - Country:US
Mailing Address - Phone:505-884-1114
Mailing Address - Fax:
Practice Address - Street 1:3901 GEORGIA ST NE STE A4
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-1391
Practice Address - Country:US
Practice Address - Phone:505-891-1583
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-15
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMC-094771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM48059251Medicaid