Viktoriya Lichtenberg

Primary specialty

Behavior TechnicianTaxonomy code 106S00000X

Practice address

369 S Holmes Ave
Shelley, ID 83274-1325

Phone

(208) 390-2305

NPI assigned

Jun 11, 2021

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Viktoriya Petruchenko Former name

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1623369600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623369600000",
    "number": "1649848136",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "369 S HOLMES AVE",
            "city": "SHELLEY",
            "state": "ID",
            "postal_code": "832741325",
            "telephone_number": "208-390-2305"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "369 S HOLMES AVE",
            "city": "SHELLEY",
            "state": "ID",
            "postal_code": "832741325",
            "telephone_number": "208-390-2305"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LICHTENBERG",
        "first_name": "VIKTORIYA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-06-11",
        "last_updated": "2021-06-11",
        "certification_date": "2021-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0002196996",
            "state": "ID"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "skillfulsoltherapy@gmail.com",
            "affiliation": "N",
            "endpointDescription": "email",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "369 S Holmes Ave",
            "city": "Shelley",
            "state": "ID",
            "country_code": "US",
            "postal_code": "832741325",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "VIKTORIYA",
            "last_name": "PETRUCHENKO",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• All providers in Shelley, ID
• Behavior Technician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.