Provider Demographics
NPI:1841026200
Name:FUSCO, VICTORIA (MA)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:FUSCO
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2115 SE ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97222-7773
Mailing Address - Country:US
Mailing Address - Phone:503-659-3480
Mailing Address - Fax:503-575-3707
Practice Address - Street 1:13110 SE SUNNYSIDE RD STE B
Practice Address - Street 2:
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015-8468
Practice Address - Country:US
Practice Address - Phone:503-659-3480
Practice Address - Fax:503-575-3707
Is Sole Proprietor?:No
Enumeration Date:2024-09-12
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional