Provider Demographics
NPI:1235557125
Name:HANLON, VICTORIA MARIE (MS, BCBA)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:MARIE
Last Name:HANLON
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 NW 1ST AVE
Mailing Address - Street 2:#L211
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33136-3541
Mailing Address - Country:US
Mailing Address - Phone:305-979-4304
Mailing Address - Fax:
Practice Address - Street 1:915 NW 1ST AVE
Practice Address - Street 2:#L211
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-3541
Practice Address - Country:US
Practice Address - Phone:305-979-4304
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-28
Last Update Date:2015-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-15-18277103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst