Provider Demographics
NPI:1154475374
Name:MARICICH, VICTORIA KAY (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:VICTORIA
Middle Name:KAY
Last Name:MARICICH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5562 TAMMARISK DR
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92886-4916
Mailing Address - Country:US
Mailing Address - Phone:714-747-5088
Mailing Address - Fax:949-223-6451
Practice Address - Street 1:1501 E 16TH ST
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-5924
Practice Address - Country:US
Practice Address - Phone:949-650-9750
Practice Address - Fax:949-650-9768
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 194141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical