Provider Demographics
NPI:1982815684
Name:VIEIRA, FAY GLADYS
Entity Type:Individual
Prefix:MRS
First Name:FAY
Middle Name:GLADYS
Last Name:VIEIRA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:793 S TRACY BLVD # 129
Mailing Address - Street 2:
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95376-4753
Mailing Address - Country:US
Mailing Address - Phone:209-601-1682
Mailing Address - Fax:209-835-8583
Practice Address - Street 1:19 E 6TH ST
Practice Address - Street 2:
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95376-4107
Practice Address - Country:US
Practice Address - Phone:209-835-8583
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2009-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor