Provider Demographics
NPI:1881811552
Name:VIERA, CAROL THERESE (PHD)
Entity type:Individual
Prefix:DR
First Name:CAROL
Middle Name:THERESE
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 1:675 VFW PARKWAY
Mailing Address - Street 2:#352
Mailing Address - City:CHESTNUT HILL
Mailing Address - State:MA
Mailing Address - Zip Code:02467-3656
Mailing Address - Country:US
Mailing Address - Phone:617-469-5584
Mailing Address - Fax:
Practice Address - Street 1:675 VFW PARKWAY
Practice Address - Street 2:#352
Practice Address - City:CHESTNUT HILL
Practice Address - State:MA
Practice Address - Zip Code:02467
Practice Address - Country:US
Practice Address - Phone:617-469-5584
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3996103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW03980OtherBCBS
MAW03980OtherBCBS