Provider Demographics
NPI:1265418339
Name:WIDTH, VICTORIA P (PHD)
Entity type:Individual
Prefix:MRS
First Name:VICTORIA
Middle Name:P
Last Name:WIDTH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:67 BEAVER AVE
Mailing Address - Street 2:SUITE 10
Mailing Address - City:ANNANDALE
Mailing Address - State:NJ
Mailing Address - Zip Code:08801-3071
Mailing Address - Country:US
Mailing Address - Phone:908-238-0065
Mailing Address - Fax:908-238-0067
Practice Address - Street 1:67 BEAVER AVE
Practice Address - Street 2:SUITE 10
Practice Address - City:ANNANDALE
Practice Address - State:NJ
Practice Address - Zip Code:08801-3071
Practice Address - Country:US
Practice Address - Phone:908-238-0065
Practice Address - Fax:908-238-0067
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ35S100389600103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0007829416OtherAETNA
NJ2101642OtherCIGNA BEHAVIORAL HEALTH
NJ0007829416OtherAETNA