Provider Demographics
NPI:1295561645
Name:COMPOCCIO, VICTORIA ANN (STUDENT INTERN)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:ANN
Last Name:COMPOCCIO
Suffix:
Gender:F
Credentials:STUDENT INTERN
Other - Prefix:
Other - First Name:TORI
Other - Middle Name:ANN
Other - Last Name:COMPOCCIO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:STUDENT INTERN
Mailing Address - Street 1:600 7TH ST NE
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-3799
Mailing Address - Country:US
Mailing Address - Phone:505-331-2476
Mailing Address - Fax:
Practice Address - Street 1:1207 GOLF COURSE RD SE STE C
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-5213
Practice Address - Country:US
Practice Address - Phone:505-994-4100
Practice Address - Fax:505-994-1229
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-11
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health