Provider Demographics
NPI:1255003844
Name:IGBENE, VICTORIA (LMSW, LGSW)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:IGBENE
Suffix:
Gender:F
Credentials:LMSW, LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3465 FORT MEADE RD # 109
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20724-2044
Mailing Address - Country:US
Mailing Address - Phone:917-455-6166
Mailing Address - Fax:
Practice Address - Street 1:2275 RESEARCH BLVD STE 500
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-6203
Practice Address - Country:US
Practice Address - Phone:917-455-6166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-01
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD27407104100000X
DC1274104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker