Provider Demographics
NPI:1508877887
Name:VIEGA, VINCENT A JR (LCSW)
Entity Type:Individual
Prefix:
First Name:VINCENT
Middle Name:A
Last Name:VIEGA
Suffix:JR
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2030 STRAITS TPKE 6
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06762-1831
Mailing Address - Country:US
Mailing Address - Phone:203-525-8558
Mailing Address - Fax:
Practice Address - Street 1:2030 STRAITS TPKE 6
Practice Address - Street 2:
Practice Address - City:MIDDLEBURY
Practice Address - State:CT
Practice Address - Zip Code:06762-1831
Practice Address - Country:US
Practice Address - Phone:203-525-8558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2015-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0027871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004154514Medicaid
CT004154514Medicaid