Provider Demographics
NPI:1528784022
Name:VICTORIA LIBBY M.S.ED., PSY.D. LLC
Entity type:Organization
Organization Name:VICTORIA LIBBY M.S.ED., PSY.D. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:GEORGETTE
Authorized Official - Last Name:LIBBY
Authorized Official - Suffix:
Authorized Official - Credentials:MSED, PSYD
Authorized Official - Phone:207-200-3103
Mailing Address - Street 1:50 MARKET ST STE 1A
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-3646
Mailing Address - Country:US
Mailing Address - Phone:207-200-3103
Mailing Address - Fax:
Practice Address - Street 1:50 MARKET ST STE 1A
Practice Address - Street 2:
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-3646
Practice Address - Country:US
Practice Address - Phone:207-200-3103
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-17
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty