Provider Demographics
NPI:1124003447
Name:VICTOR, JANICE MARIE (LCSW)
Entity type:Individual
Prefix:MS
First Name:JANICE
Middle Name:MARIE
Last Name:VICTOR
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 MAGNOLIA LN
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07006-5554
Mailing Address - Country:US
Mailing Address - Phone:973-226-7662
Mailing Address - Fax:973-226-7776
Practice Address - Street 1:24 MAGNOLIA LN
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:NJ
Practice Address - Zip Code:07006-5554
Practice Address - Country:US
Practice Address - Phone:973-226-7662
Practice Address - Fax:973-226-7776
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-09
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC001487001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ647958Medicare ID - Type Unspecified