Provider Demographics
NPI:1013325794
Name:WALDEN, VICTORIA (MS ED)
Entity Type:Individual
Prefix:MS
First Name:VICTORIA
Middle Name:
Last Name:WALDEN
Suffix:
Gender:F
Credentials:MS ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 2ND AVE
Mailing Address - Street 2:17A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-4010
Mailing Address - Country:US
Mailing Address - Phone:917-204-3716
Mailing Address - Fax:
Practice Address - Street 1:400 2ND AVE
Practice Address - Street 2:17A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-4010
Practice Address - Country:US
Practice Address - Phone:917-204-3716
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-26
Last Update Date:2014-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY618165121174400000X
NY618164121174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist