Provider Demographics
NPI:1619416641
Name:ANDERSON, VICTORIA ROSE (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:VICTORIA
Middle Name:ROSE
Last Name:ANDERSON
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 1:274 RONKONKOMA AVE
Mailing Address - Street 2:
Mailing Address - City:RONKONKOMA
Mailing Address - State:NY
Mailing Address - Zip Code:11779-5445
Mailing Address - Country:US
Mailing Address - Phone:917-288-0884
Mailing Address - Fax:
Practice Address - Street 1:1300 JERICHO TPKE STE 203
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040-4601
Practice Address - Country:US
Practice Address - Phone:516-441-0870
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-23
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health