Provider Demographics
NPI:1275764276
Name:DES VIGNES, VICTORIA
Entity Type:Individual
Prefix:MRS
First Name:VICTORIA
Middle Name:
Last Name:DES VIGNES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:
Other - Last Name:KELLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, MS
Mailing Address - Street 1:2150 85TH ST # 1
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-3212
Mailing Address - Country:US
Mailing Address - Phone:347-673-7144
Mailing Address - Fax:
Practice Address - Street 1:2150 85TH ST # 1
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214-3212
Practice Address - Country:US
Practice Address - Phone:347-673-7144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-07
Last Update Date:2009-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool