Provider Demographics
NPI:1417224825
Name:VICTORIA REID PHD
Entity Type:Organization
Organization Name:VICTORIA REID PHD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:J
Authorized Official - Last Name:NEWMAN
Authorized Official - Suffix:
Authorized Official - Credentials:BA CPC
Authorized Official - Phone:708-560-6653
Mailing Address - Street 1:15020 S RAVINIA ROAD
Mailing Address - Street 2:SUITE 23
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462
Mailing Address - Country:US
Mailing Address - Phone:708-403-4055
Mailing Address - Fax:
Practice Address - Street 1:15020 S RAVINIA AVE
Practice Address - Street 2:SUITE 23
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-3166
Practice Address - Country:US
Practice Address - Phone:708-403-4055
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-30
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071005245103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty