Provider Demographics
NPI:1205532850
Name:VIERA, JANICE ELISA (PHD)
Entity type:Individual
Prefix:DR
First Name:JANICE
Middle Name:ELISA
Last Name:VIERA
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 1:839 CALLE ANASCO
Mailing Address - Street 2:APT 208 PLAZA UNIVERSIDAD 2000
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00925
Mailing Address - Country:US
Mailing Address - Phone:787-429-9726
Mailing Address - Fax:
Practice Address - Street 1:511 AVE HOSTOS STE 103
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-3247
Practice Address - Country:US
Practice Address - Phone:787-429-9726
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-06
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7297103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical