Provider Demographics
NPI:1003260464
Name:DESJARDIN, VICTORIA (MS, BCBA/LBA)
Entity Type:Individual
Prefix:MRS
First Name:VICTORIA
Middle Name:
Last Name:DESJARDIN
Suffix:
Gender:F
Credentials:MS, BCBA/LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 SKYLINE DR
Mailing Address - Street 2:
Mailing Address - City:PROSPECT
Mailing Address - State:CT
Mailing Address - Zip Code:06712-1732
Mailing Address - Country:US
Mailing Address - Phone:860-921-6484
Mailing Address - Fax:
Practice Address - Street 1:680 MIX AVE APT 2G
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06514-2364
Practice Address - Country:US
Practice Address - Phone:860-921-6484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-21
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor