Provider Demographics
NPI:1104960533
Name:SCIARRA, VICTORIA (MFT)
Entity type:Individual
Prefix:MRS
First Name:VICTORIA
Middle Name:
Last Name:SCIARRA
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4529 LEVELSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90712-3651
Mailing Address - Country:US
Mailing Address - Phone:562-420-3002
Mailing Address - Fax:
Practice Address - Street 1:4182 N VIKING WAY STE 204
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90808-1474
Practice Address - Country:US
Practice Address - Phone:562-420-3002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC28717106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist