Michelle Renee Victoria, LP PHD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

6301018352 Issued in MI

Practice address

44000 W 12 Mile Rd Ste 101
Novi, MI 48377-2646

Phone

(248) 226-3001

Fax

(248) 347-6479

NPI assigned

Feb 26, 2016

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Henry Ford Health Eastwood Behavioral HealthGroup PAC ID 2163324492, 51 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mvictoriaphd1156596@direct.hfhs.org

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Henry Ford Health Eastwood Behavioral Health

  dba Eastwood Clinics

  • Social Worker
  • Clinton Township, MI
  • NPI 1396787701
  Medicare reassignment Care Compare group NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1456444800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1602201600000",
    "number": "1285094789",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "44000 W 12 MILE RD",
            "city": "NOVI",
            "state": "MI",
            "postal_code": "483772644",
            "telephone_number": "856-981-0894"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "44000 W 12 MILE RD STE 101",
            "city": "NOVI",
            "state": "MI",
            "postal_code": "483772646",
            "telephone_number": "248-226-3001",
            "fax_number": "248-347-6479"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VICTORIA",
        "first_name": "MICHELLE",
        "middle_name": "RENEE",
        "credential": "LP PHD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-02-26",
        "last_updated": "2020-10-09",
        "certification_date": "2020-09-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NJ",
            "license": "SI5583",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MI",
            "license": "6301018352",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• VHS Physicians of Michigan
• VHS Physicians of Michigan
• VHS Physicians of Michigan
• Vicinity Medical Partners PA
• Emily Victor
• Kelly Lynn Vigants, ED.S.
• Alicia Vigil
• Monique Angel Vigil
• Rebecca Vigiletti
• Nicole Vignasse

• Clinical Psychologist in Novi, MI
• Providers in Novi, MI by specialty
• Clinical Psychologist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.