Provider Demographics
NPI:1801099106
Name:GROSSO-GODDARD, VICTORIA CATALINA
Entity type:Individual
Prefix:DR
First Name:VICTORIA
Middle Name:CATALINA
Last Name:GROSSO-GODDARD
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:VICTORIA
Other - Middle Name:CATALINA
Other - Last Name:GROSSO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:359 W END RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07079-1445
Mailing Address - Country:US
Mailing Address - Phone:973-378-8873
Mailing Address - Fax:
Practice Address - Street 1:2920 BROADWAY
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10027-7004
Practice Address - Country:US
Practice Address - Phone:212-854-2878
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011787 1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical