Provider Demographics
NPI:1396001707
Name:MICHALEK, VICTORIA FERN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:VICTORIA
Middle Name:FERN
Last Name:MICHALEK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 SCHOOL ST
Mailing Address - Street 2:SUITE 3B
Mailing Address - City:BETHEL
Mailing Address - State:CT
Mailing Address - Zip Code:06801-1855
Mailing Address - Country:US
Mailing Address - Phone:203-648-2886
Mailing Address - Fax:
Practice Address - Street 1:7 SCHOOL ST
Practice Address - Street 2:SUITE 3B
Practice Address - City:BETHEL
Practice Address - State:CT
Practice Address - Zip Code:06801-1855
Practice Address - Country:US
Practice Address - Phone:203-648-2886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-10
Last Update Date:2015-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0079311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical