Provider Demographics
NPI:1184056921
Name:BAINES, VICTORIA LEE
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:LEE
Last Name:BAINES
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 1:187 FLAX HILL RD
Mailing Address - Street 2:D1
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06854-2847
Mailing Address - Country:US
Mailing Address - Phone:347-249-2071
Mailing Address - Fax:
Practice Address - Street 1:187 FLAX HILL RD
Practice Address - Street 2:D1
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06854-2847
Practice Address - Country:US
Practice Address - Phone:347-249-2071
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-03
Last Update Date:2013-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst