Provider Demographics
NPI:1679068134
Name:PISKAC, VICTORIA A (LICDC, LSW)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:A
Last Name:PISKAC
Suffix:
Gender:F
Credentials:LICDC, LSW
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:A
Other - Last Name:MESSENGER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:35077 ELM RD
Mailing Address - Street 2:
Mailing Address - City:GRAFTON
Mailing Address - State:OH
Mailing Address - Zip Code:44044-9551
Mailing Address - Country:US
Mailing Address - Phone:419-690-2528
Mailing Address - Fax:
Practice Address - Street 1:14701 DETROIT AVE STE 588
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:OH
Practice Address - Zip Code:44107-4115
Practice Address - Country:US
Practice Address - Phone:216-530-4770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-27
Last Update Date:2025-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLICDC.161933101YA0400X
OHS.2005035104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH280760OtherMEDICARE