Provider Demographics
NPI:1447446323
Name:MATICA, VICTORIA ILONA
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:ILONA
Last Name:MATICA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:VICKIE
Other - Middle Name:ILONA
Other - Last Name:MATICA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:490 MILL ST
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-1026
Mailing Address - Country:US
Mailing Address - Phone:775-324-2622
Mailing Address - Fax:
Practice Address - Street 1:490 MILL ST
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-1026
Practice Address - Country:US
Practice Address - Phone:775-324-2622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-24
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health