Provider Demographics
NPI:1083094791
Name:JOHNSON, VICTORIA LECORIAN (MD)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:LECORIAN
Last Name:JOHNSON
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:L
Other - Last Name:JOHNSON- RIVERS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:804 FAIRVIEW LN APT 2
Mailing Address - Street 2:
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-1568
Mailing Address - Country:US
Mailing Address - Phone:478-719-7682
Mailing Address - Fax:551-236-2513
Practice Address - Street 1:804 FAIRVIEW LN APT 2
Practice Address - Street 2:
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-1568
Practice Address - Country:US
Practice Address - Phone:478-719-7682
Practice Address - Fax:551-236-2513
Is Sole Proprietor?:No
Enumeration Date:2015-06-08
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1845052084P0800X, 2084P0804X
NY3035972084P0800X, 2084P0804X
MIEMC00023472084P0800X, 2084P0804X
ORMD2235822084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry