Provider Demographics
NPI:1407978885
Name:LIBAN, VICTORIA M (LCSW)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:M
Last Name:LIBAN
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 1:780 WELCH RD
Mailing Address - Street 2:SUITE 207
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94304-1516
Mailing Address - Country:US
Mailing Address - Phone:650-498-8167
Mailing Address - Fax:
Practice Address - Street 1:780 WELCH RD
Practice Address - Street 2:SUITE 207
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94304-1516
Practice Address - Country:US
Practice Address - Phone:650-498-8167
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS16001101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health