Provider Demographics
NPI:1992218473
Name:MENZEL, MARIA VICTORIA (LSW)
Entity Type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:VICTORIA
Last Name:MENZEL
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:VICTORIA
Other - Last Name:SANTIAGO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:18 W BLACKWELL ST
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07801-3841
Mailing Address - Country:US
Mailing Address - Phone:973-328-3344
Mailing Address - Fax:973-862-6650
Practice Address - Street 1:18 W BLACKWELL ST
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:NJ
Practice Address - Zip Code:07801-3841
Practice Address - Country:US
Practice Address - Phone:973-328-3344
Practice Address - Fax:973-862-6650
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-07
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL06267200104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker