Provider Demographics
NPI:1083083414
Name:HAVRON, VICTORIA MARUCA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:VICTORIA
Middle Name:MARUCA
Last Name:HAVRON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:LYNN
Other - Last Name:MARUCA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:130 DUDLEY PIKE STE 195
Mailing Address - Street 2:
Mailing Address - City:EDGEWOOD
Mailing Address - State:KY
Mailing Address - Zip Code:41017-2502
Mailing Address - Country:US
Mailing Address - Phone:859-910-0988
Mailing Address - Fax:
Practice Address - Street 1:130 DUDLEY PIKE STE 195
Practice Address - Street 2:
Practice Address - City:EDGEWOOD
Practice Address - State:KY
Practice Address - Zip Code:41017-2502
Practice Address - Country:US
Practice Address - Phone:859-910-0988
Practice Address - Fax:859-910-0988
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-16
Last Update Date:2023-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY242770103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist