1952491318 NPI number — DR. OLGA MARINA VIERA PSY.D., LMHC

Table of content: DR. OLGA MARINA VIERA PSY.D., LMHC (NPI 1952491318)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952491318 NPI number — DR. OLGA MARINA VIERA PSY.D., LMHC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VIERA
Provider First Name:
OLGA
Provider Middle Name:
MARINA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PSY.D., LMHC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RIVERA
Provider Other First Name:
OLGA
Provider Other Middle Name:
MARINA
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PSY.D., LMHC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1952491318
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/17/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5448 HOFFNER AVE STE 307
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ORLANDO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32812-2508
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-930-7317
Provider Business Mailing Address Fax Number:
407-850-8142

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5448 HOFFNER AVE STE 307
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ORLANDO
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32812-2508
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-930-7317
Provider Business Practice Location Address Fax Number:
407-850-8142
Provider Enumeration Date:
10/13/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  MH3152 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 005574800 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".