Provider Demographics
NPI:1124169735
Name:PRIOLA, VICTORIA (PSYD)
Entity type:Individual
Prefix:DR
First Name:VICTORIA
Middle Name:
Last Name:PRIOLA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:912 BLAZING STAR RD
Mailing Address - Street 2:
Mailing Address - City:GRAYSLAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60030-3555
Mailing Address - Country:US
Mailing Address - Phone:773-332-7692
Mailing Address - Fax:847-816-9724
Practice Address - Street 1:1641 N MILWAUKEE AVE
Practice Address - Street 2:
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-1350
Practice Address - Country:US
Practice Address - Phone:773-332-7692
Practice Address - Fax:847-816-9724
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071006158103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01635735OtherBCBS OF ILLINOIS PROVIDER
IL01635735OtherBCBS OF ILLINOIS PROVIDER