Provider Demographics
NPI:1730942517
Name:SMITH, VICTORIA A
Entity type:Individual
Prefix:MRS
First Name:VICTORIA
Middle Name:A
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1245 W MARINE DR APT 8
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:OR
Mailing Address - Zip Code:97103-5641
Mailing Address - Country:US
Mailing Address - Phone:707-623-4115
Mailing Address - Fax:
Practice Address - Street 1:1245 W MARINE DR APT 8
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:OR
Practice Address - Zip Code:97103-5641
Practice Address - Country:US
Practice Address - Phone:707-623-4115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-05
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician