Provider Demographics
NPI:1467768788
Name:VIGGIANI, SANDRA ISABEL (PHD)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:ISABEL
Last Name:VIGGIANI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 LAKESHORE DR STE 1695
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70629-0124
Mailing Address - Country:US
Mailing Address - Phone:337-564-6405
Mailing Address - Fax:337-656-2563
Practice Address - Street 1:1 LAKESHORE DR STE 1695
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70629-0124
Practice Address - Country:US
Practice Address - Phone:337-564-6405
Practice Address - Fax:337-656-2563
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-24
Last Update Date:2019-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1387103TC0700X
CA30290103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical