MEDICARE: ALINA S. VIOLA PSY.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	071007391	IL

General Provider Information

NPI Number	:	1225210784
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALINA S. VIOLA PSY.D.

Provider Business Mailing Address
First Line	:	4256 N RAVENSWOOD AVE
Second Line	:	STE. 302
City	:	CHICAGO
State	:	IL
Zip	:	60613-1110
Country	:	US
Telephone Number	:	773-398-7562
Fax Number	:	773-398-7562

Provider Business Practice Location Address
First Line	:	4256 N RAVENSWOOD AVE
Second Line	:	STE. 302
City	:	CHICAGO
State	:	IL
Zip	:	60613-1110
Country	:	US
Telephone Number	:	773-398-7562
Fax Number	:	773-398-7562

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/27/2007
Last Update Date	:	03/18/2013

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