Provider Demographics
NPI:1336792837
Name:SOTELO, VICTORIA M (LMFT)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:M
Last Name:SOTELO
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:
Other - Last Name:MAHAIRAS-SOTELO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:401 W 261ST ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10471-1126
Mailing Address - Country:US
Mailing Address - Phone:917-364-5151
Mailing Address - Fax:
Practice Address - Street 1:380 LEXINGTON AVE STE 1722
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10168-0002
Practice Address - Country:US
Practice Address - Phone:646-543-4026
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-23
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001315106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist