Provider Demographics
NPI:1275601999
Name:VICTORIA, MARIA LUISA (PHD)
Entity Type:Individual
Prefix:
First Name:MARIA LUISA
Middle Name:
Last Name:VICTORIA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76 COLUMBIA ST # 2
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-2432
Mailing Address - Country:US
Mailing Address - Phone:617-277-5878
Mailing Address - Fax:
Practice Address - Street 1:370 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02445-6874
Practice Address - Country:US
Practice Address - Phone:617-277-5878
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7218103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist