Provider Demographics
NPI:1700404373
Name:KIARSIS, VICTOR (LMSW)
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:
Last Name:KIARSIS
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 ELM PL
Mailing Address - Street 2:
Mailing Address - City:RYE
Mailing Address - State:NY
Mailing Address - Zip Code:10580-2951
Mailing Address - Country:US
Mailing Address - Phone:914-261-5057
Mailing Address - Fax:
Practice Address - Street 1:14 ELM PL
Practice Address - Street 2:
Practice Address - City:RYE
Practice Address - State:NY
Practice Address - Zip Code:10580-2951
Practice Address - Country:US
Practice Address - Phone:914-261-5057
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-10
Last Update Date:2020-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY101497101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health