Provider Demographics
NPI:1548942618
Name:EMANUEL, VICTORIA SHAY I
Entity type:Individual
Prefix:MISS
First Name:VICTORIA
Middle Name:SHAY
Last Name:EMANUEL
Suffix:I
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:VICTORIA
Other - Middle Name:SHAY
Other - Last Name:EMANUEL
Other - Suffix:I
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:20 SUGAR HILL DR
Mailing Address - Street 2:
Mailing Address - City:HILLSBOROUGH
Mailing Address - State:CA
Mailing Address - Zip Code:94010-7420
Mailing Address - Country:US
Mailing Address - Phone:650-387-2557
Mailing Address - Fax:
Practice Address - Street 1:800 SOUTH BROADWAY SUITE. 301
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596
Practice Address - Country:US
Practice Address - Phone:888-531-8385
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-07
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician