Provider Demographics
NPI:1891993911
Name:VIEGAS MILLER, BABITA (PHD)
Entity Type:Individual
Prefix:DR
First Name:BABITA
Middle Name:
Last Name:VIEGAS MILLER
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 1:1480 RENAISSANCE DR
Mailing Address - Street 2:SUITE 205
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-1332
Mailing Address - Country:US
Mailing Address - Phone:847-751-4651
Mailing Address - Fax:
Practice Address - Street 1:1480 RENAISSANCE DR
Practice Address - Street 2:SUITE 205
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-1332
Practice Address - Country:US
Practice Address - Phone:847-751-4651
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-10
Last Update Date:2010-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.006750103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK11936Medicare PIN