Provider Demographics
NPI:1407693831
Name:HOTHAM, VICTORIA (LMSW)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:HOTHAM
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 PINE ST APT 406
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06040-5879
Mailing Address - Country:US
Mailing Address - Phone:860-327-2590
Mailing Address - Fax:
Practice Address - Street 1:63 E CENTER ST # 2R
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06040-5221
Practice Address - Country:US
Practice Address - Phone:860-281-1133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-12
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT97541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical