Provider Demographics
NPI:1720533573
Name:ST. VICTOR, NATASHA (LCSW)
Entity Type:Individual
Prefix:
First Name:NATASHA
Middle Name:
Last Name:ST. VICTOR
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:955 SAVANNAH CIR
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-6452
Mailing Address - Country:US
Mailing Address - Phone:630-476-0674
Mailing Address - Fax:
Practice Address - Street 1:955 SAVANNAH CIR
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-6452
Practice Address - Country:US
Practice Address - Phone:630-476-0674
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-22
Last Update Date:2016-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490181921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical