Provider Demographics
NPI:1407355779
Name:SHIN, VICTORIA (LMHC)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:SHIN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1225 FRANKLIN AVE STE 325
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-1693
Mailing Address - Country:US
Mailing Address - Phone:347-745-8195
Mailing Address - Fax:
Practice Address - Street 1:1225 FRANKLIN AVE STE 325
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-1693
Practice Address - Country:US
Practice Address - Phone:347-745-8195
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-01
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010269101YM0800X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health