Provider Demographics
NPI:1336579010
Name:JANICE VICTOR
Entity Type:Organization
Organization Name:JANICE VICTOR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:MS
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:VICTOR
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:973-744-3550
Mailing Address - Street 1:248 LORRAINE AVE
Mailing Address - Street 2:SUITE#3
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07043-1454
Mailing Address - Country:US
Mailing Address - Phone:862-368-2670
Mailing Address - Fax:973-744-3550
Practice Address - Street 1:248 LORRAINE AVE
Practice Address - Street 2:SUITE#3
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07043-1454
Practice Address - Country:US
Practice Address - Phone:862-368-2670
Practice Address - Fax:973-744-3550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-18
Last Update Date:2013-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC00148700261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
647958Medicare PIN