Provider Demographics
NPI:1780120832
Name:VIEIRA, MALIA P (LMFT)
Entity type:Individual
Prefix:
First Name:MALIA
Middle Name:P
Last Name:VIEIRA
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:531 MAIN ST
Mailing Address - Street 2:#824
Mailing Address - City:EL SEGUNDO
Mailing Address - State:CA
Mailing Address - Zip Code:90245-3060
Mailing Address - Country:US
Mailing Address - Phone:714-227-3515
Mailing Address - Fax:
Practice Address - Street 1:16255 VENTURA BLVD
Practice Address - Street 2:#502
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2302
Practice Address - Country:US
Practice Address - Phone:310-658-3089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-13
Last Update Date:2017-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA85400106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist