Provider Demographics
NPI:1447600838
Name:VIERA, ALICIA (PSYD)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:VIERA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16W289 83RD ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:BURR RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60527-5876
Mailing Address - Country:US
Mailing Address - Phone:630-891-3027
Mailing Address - Fax:
Practice Address - Street 1:16W289 83RD ST
Practice Address - Street 2:SUITE C
Practice Address - City:BURR RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60527-5876
Practice Address - Country:US
Practice Address - Phone:630-891-3027
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-15
Last Update Date:2016-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071009316103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical