Provider Demographics
NPI:1720703705
Name:DIRUBBA, VICTORIA JAINE
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:JAINE
Last Name:DIRUBBA
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 1:436 TRUMP PARK
Mailing Address - Street 2:
Mailing Address - City:SHRUB OAK
Mailing Address - State:NY
Mailing Address - Zip Code:10588-1212
Mailing Address - Country:US
Mailing Address - Phone:845-745-8010
Mailing Address - Fax:
Practice Address - Street 1:360 STATE ROUTE 17M STE 4
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NY
Practice Address - Zip Code:10950-3444
Practice Address - Country:US
Practice Address - Phone:845-547-0479
Practice Address - Fax:845-999-4610
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-11
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
NY1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health