Provider Demographics
NPI:1770754285
Name:HUERTAS, VICTOR M (PSYD)
Entity type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:M
Last Name:HUERTAS
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8232 LA FAYE CT
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22306-3200
Mailing Address - Country:US
Mailing Address - Phone:202-360-8582
Mailing Address - Fax:703-780-4898
Practice Address - Street 1:8232 LA FAYE CT
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22306-3200
Practice Address - Country:US
Practice Address - Phone:202-360-8582
Practice Address - Fax:703-780-4898
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-13
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810003128103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent