Provider Demographics
NPI:1316773344
Name:PHOENIX, VICTORIA (PSYD)
Entity type:Individual
Prefix:DR
First Name:VICTORIA
Middle Name:
Last Name:PHOENIX
Suffix:
Gender:
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2174 HEWLETT AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-3620
Mailing Address - Country:US
Mailing Address - Phone:516-858-2877
Mailing Address - Fax:
Practice Address - Street 1:2174 HEWLETT AVE STE 200
Practice Address - Street 2:
Practice Address - City:MERRICK
Practice Address - State:NY
Practice Address - Zip Code:11566-3620
Practice Address - Country:US
Practice Address - Phone:516-858-2877
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-09
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY68-P130858-01103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist