Provider Demographics
NPI:1518650431
Name:DICIANNI, VICTORIA ANNA
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:ANNA
Last Name:DICIANNI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 SAINT ROSE ST APT 2
Mailing Address - Street 2:
Mailing Address - City:JAMAICA PLAIN
Mailing Address - State:MA
Mailing Address - Zip Code:02130-3956
Mailing Address - Country:US
Mailing Address - Phone:508-808-8531
Mailing Address - Fax:
Practice Address - Street 1:1 BOSTON PL # MA02109
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02108-4407
Practice Address - Country:US
Practice Address - Phone:508-808-8531
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-26
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA000226841104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker