Provider Demographics
NPI:1528621224
Name:ENEREMADU, VICTORIA
Entity type:Individual
Prefix:PROF
First Name:VICTORIA
Middle Name:
Last Name:ENEREMADU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9531 WESLAND CIR
Mailing Address - Street 2:
Mailing Address - City:RANDALLSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21133-2040
Mailing Address - Country:US
Mailing Address - Phone:443-985-7392
Mailing Address - Fax:
Practice Address - Street 1:9531 WESLAND CIR
Practice Address - Street 2:
Practice Address - City:RANDALLSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21133-2040
Practice Address - Country:US
Practice Address - Phone:443-985-7392
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-17
Last Update Date:2019-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD141331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical