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General NPI Number Information
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NPI Number | 1306928973
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Entity Type | Organization
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Legal Business Name | VIERA PSYCHOLOGICAL SERVICES PA
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Dates
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Enumeration Date | 10/20/2006
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Last Update Date | 03/23/2010
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Provider Practice Location Address
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Address Line | 345 6TH AVE
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City | INDIALANTIC
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State | FL
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Zip | 32903-4301
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Country | US
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Telephone | 321-951-2100
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Fax | 321-951-1204
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Provider Business Mailing Address
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Address Line | 345 6TH AVE
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City | INDIALANTIC
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State | FL
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Zip | 32903-4301
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Country | US
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Telephone | 321-951-2100
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Fax | 321-951-1204
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Authorized Official
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Title or Position | OWNER
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Name | DR. JASON WIESELER
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Credential | PSY.D.
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Telephone | 321-704-1135
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY7276
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License Number State | FL
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