Provider Demographics
NPI:1154652352
Name:DEMOSTHENE, VICTORIA (RN, MSN, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:DEMOSTHENE
Suffix:
Gender:F
Credentials:RN, MSN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:765 E ROUTE 70
Mailing Address - Street 2:SUITE A-100
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-2341
Mailing Address - Country:US
Mailing Address - Phone:856-797-4721
Mailing Address - Fax:856-797-4785
Practice Address - Street 1:765 E ROUTE 70
Practice Address - Street 2:SUITE A-100
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-2341
Practice Address - Country:US
Practice Address - Phone:856-797-4721
Practice Address - Fax:856-797-4785
Is Sole Proprietor?:No
Enumeration Date:2010-01-27
Last Update Date:2010-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00275500363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health