Provider Demographics
NPI:1225485659
Name:STEIN, VICTORIA (PSYD)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:STEIN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2373 BROADWAY
Mailing Address - Street 2:529
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-2800
Mailing Address - Country:US
Mailing Address - Phone:917-288-0028
Mailing Address - Fax:
Practice Address - Street 1:2373 BROADWAY
Practice Address - Street 2:529
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-2800
Practice Address - Country:US
Practice Address - Phone:917-288-0028
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-16
Last Update Date:2017-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021605-1103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical