Provider Demographics
NPI:1306390893
Name:BAPTISTE, VICTORIA M (PHD)
Entity Type:Individual
Prefix:DR
First Name:VICTORIA
Middle Name:M
Last Name:BAPTISTE
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 1:121 SAN ANSELMO AVENUE
Mailing Address - Street 2:P.O. BOX 1735
Mailing Address - City:SAN ANSELMO
Mailing Address - State:CA
Mailing Address - Zip Code:94979
Mailing Address - Country:US
Mailing Address - Phone:802-318-3138
Mailing Address - Fax:
Practice Address - Street 1:4361 RAILROAD AVE
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94566-6611
Practice Address - Country:US
Practice Address - Phone:415-991-3031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-12
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA32587103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program