Provider Demographics
NPI:1447928205
Name:EGAN, VICTORIA LEIGH (MA)
Entity type:Individual
Prefix:MRS
First Name:VICTORIA
Middle Name:LEIGH
Last Name:EGAN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:LEIGH
Other - Last Name:RAIMONDI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:202 PLAYHOUSE COR
Mailing Address - Street 2:
Mailing Address - City:SOUTHBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06488-2265
Mailing Address - Country:US
Mailing Address - Phone:203-954-0543
Mailing Address - Fax:
Practice Address - Street 1:202 PLAYHOUSE COR
Practice Address - Street 2:
Practice Address - City:SOUTHBURY
Practice Address - State:CT
Practice Address - Zip Code:06488-2265
Practice Address - Country:US
Practice Address - Phone:203-954-0543
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-05
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT5216101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional