Provider Demographics
NPI:1770755613
Name:VIOLA, STEPHEN G (PHD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:G
Last Name:VIOLA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 WASHINGTON AVE
Mailing Address - Street 2:#411
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63103-1650
Mailing Address - Country:US
Mailing Address - Phone:314-588-8975
Mailing Address - Fax:
Practice Address - Street 1:2020 WASHINGTON AVE
Practice Address - Street 2:#411
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63103-1650
Practice Address - Country:US
Practice Address - Phone:314-588-8975
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-01
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool