Provider Demographics
NPI:1942531272
Name:VICTOR, OLGA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:OLGA
Middle Name:
Last Name:VICTOR
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:661 EAST DR
Mailing Address - Street 2:
Mailing Address - City:ORADELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07649-1211
Mailing Address - Country:US
Mailing Address - Phone:201-967-5453
Mailing Address - Fax:
Practice Address - Street 1:2780 RESERVOIR AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10468-2702
Practice Address - Country:US
Practice Address - Phone:718-329-8589
Practice Address - Fax:718-562-4357
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-27
Last Update Date:2010-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP0472571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical