Provider Demographics
NPI:1710375761
Name:VIARA, ERIC
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:VIARA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 N MAIN ST
Mailing Address - Street 2:SUITE 130
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06042-2086
Mailing Address - Country:US
Mailing Address - Phone:860-533-3434
Mailing Address - Fax:860-647-6829
Practice Address - Street 1:71 HAYNES ST
Practice Address - Street 2:SUITE 1412
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06040-4131
Practice Address - Country:US
Practice Address - Phone:860-647-6832
Practice Address - Fax:860-647-6831
Is Sole Proprietor?:No
Enumeration Date:2014-12-29
Last Update Date:2014-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1115101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004025177Medicaid