Provider Demographics
NPI:1205577905
Name:VICTORY, ERROL CHRISTOPHER
Entity type:Individual
Prefix:PROF
First Name:ERROL
Middle Name:CHRISTOPHER
Last Name:VICTORY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1077 E 73RD ST APT 3
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-5363
Mailing Address - Country:US
Mailing Address - Phone:917-439-7853
Mailing Address - Fax:
Practice Address - Street 1:1077 E 73RD ST APT 3
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-5363
Practice Address - Country:US
Practice Address - Phone:917-439-7853
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-05
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011887101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health