Provider Demographics
NPI:1770615239
Name:VIEIRA, ALICE THIE (PHD)
Entity type:Individual
Prefix:DR
First Name:ALICE
Middle Name:THIE
Last Name:VIEIRA
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 1:2124 VISTA LAREDO
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-4041
Mailing Address - Country:US
Mailing Address - Phone:949-720-9464
Mailing Address - Fax:949-760-1475
Practice Address - Street 1:2124 VISTA LAREDO
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-4041
Practice Address - Country:US
Practice Address - Phone:949-720-9464
Practice Address - Fax:949-760-1475
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 9614103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist