Provider Demographics
NPI:1629755038
Name:BYCZKIEWICZ, VIKTORIA WALDA (PHD)
Entity Type:Individual
Prefix:DR
First Name:VIKTORIA
Middle Name:WALDA
Last Name:BYCZKIEWICZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:819 DIAMOND DR
Mailing Address - Street 2:
Mailing Address - City:ARCATA
Mailing Address - State:CA
Mailing Address - Zip Code:95521-8215
Mailing Address - Country:US
Mailing Address - Phone:213-422-3063
Mailing Address - Fax:
Practice Address - Street 1:801 CRESCENT WAY STE 3
Practice Address - Street 2:
Practice Address - City:ARCATA
Practice Address - State:CA
Practice Address - Zip Code:95521-6781
Practice Address - Country:US
Practice Address - Phone:707-677-8200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-28
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSB94027525103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSB94027525OtherREGISTERED PSYCHOLOGICAL ASSOCIATE LICENSE