Provider Demographics
NPI:1093263709
Name:MATTIMORE, VICTORIA (MA)
Entity Type:Individual
Prefix:MRS
First Name:VICTORIA
Middle Name:
Last Name:MATTIMORE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MS
Other - First Name:VICTORIA
Other - Middle Name:
Other - Last Name:ARCHULETA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:333 ESTUDILLO AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94577-4717
Mailing Address - Country:US
Mailing Address - Phone:510-782-0950
Mailing Address - Fax:510-782-0970
Practice Address - Street 1:333 ESTUDILLO AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94577-4717
Practice Address - Country:US
Practice Address - Phone:510-782-0950
Practice Address - Fax:510-782-0970
Is Sole Proprietor?:No
Enumeration Date:2016-09-12
Last Update Date:2016-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst