Provider Demographics
NPI:1104627231
Name:THERAPY WITH VICTOR TRUSSELL LLC
Entity type:Organization
Organization Name:THERAPY WITH VICTOR TRUSSELL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:TRUSSELL
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:571-992-9053
Mailing Address - Street 1:1135 S DIVINITY ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19143-4301
Mailing Address - Country:US
Mailing Address - Phone:571-992-9053
Mailing Address - Fax:
Practice Address - Street 1:1135 S DIVINITY ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19143
Practice Address - Country:US
Practice Address - Phone:571-992-9053
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-24
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty