Provider Demographics
NPI:1396866679
Name:DEMOS, VICTORIA C (PHD)
Entity Type:Individual
Prefix:DR
First Name:VICTORIA
Middle Name:C
Last Name:DEMOS
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 1:1559 POST RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824-5933
Mailing Address - Country:US
Mailing Address - Phone:917-406-2456
Mailing Address - Fax:
Practice Address - Street 1:300 MERCER ST APT 3L
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-6732
Practice Address - Country:US
Practice Address - Phone:917-406-2456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2022-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010570-1103TC0700X
CT003325103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical