Provider Demographics
NPI:1518560176
Name:MAPURA, VICTORIA R (LAC)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:R
Last Name:MAPURA
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 FAIRFIELD AVE STE 1C
Mailing Address - Street 2:
Mailing Address - City:WEST CALDWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07006-6415
Mailing Address - Country:US
Mailing Address - Phone:201-919-7459
Mailing Address - Fax:
Practice Address - Street 1:175 FAIRFIELD AVE STE 1C
Practice Address - Street 2:
Practice Address - City:WEST CALDWELL
Practice Address - State:NJ
Practice Address - Zip Code:07006-6415
Practice Address - Country:US
Practice Address - Phone:201-919-7459
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-17
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00551700101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health