Provider Demographics
NPI:1598269219
Name:LASSETTRE, VICTORIA NOEL
Entity Type:Individual
Prefix:MS
First Name:VICTORIA
Middle Name:NOEL
Last Name:LASSETTRE
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 1:1333 S MAYFLOWER AVE STE 220
Mailing Address - Street 2:
Mailing Address - City:MONROVIA
Mailing Address - State:CA
Mailing Address - Zip Code:91016-5239
Mailing Address - Country:US
Mailing Address - Phone:888-805-0759
Mailing Address - Fax:877-207-9553
Practice Address - Street 1:1485 SARATOGA AVE STE 200
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95129-4965
Practice Address - Country:US
Practice Address - Phone:877-991-0009
Practice Address - Fax:877-207-9553
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-19
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
CA1-23-63797103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician