Individual provider Active NPI

Victoria Priola, PSYD

  • Clinical Psychologist
  • Libertyville, IL
National Provider Identifier
1124169735
Registry record updated Jan 27, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
071006158 Issued in IL
Practice address
1641 N Milwaukee Ave
Libertyville, IL 60048-1350
Phone
(773) 332-7692
Fax
(847) 816-9724
NPI assigned
Feb 8, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 27, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 071006158 IL Primary

Addresses

Primary practice location

1641 N Milwaukee Ave
Libertyville, IL 60048-1350

Mailing address

912 Blazing Star Rd
Grayslake, IL 60030-3555
Phone (773) 332-7692

Other identifiers 1

IdentifierTypeStateIssuer
01635735OtherILBCBS OF ILLINOIS PROVIDER

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150127000314 IL Practitioner - Clinical Psychologist 6305866856 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

801 S Milwaukee Ave
Libertyville, IL 60048-3204
Phone (847) 986-9757

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Powers Wellness & Consulting Group, LLC Clinical CurrentSince Aug 20, 2014 Accepting new patients

Locations

801 S Milwaukee Ave
Libertyville, IL 60048
Phone (847) 362-2900

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170892800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1422316800000",
    "number": "1124169735",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "912 BLAZING STAR RD",
            "city": "GRAYSLAKE",
            "state": "IL",
            "postal_code": "600303555",
            "telephone_number": "773-332-7692",
            "fax_number": "847-816-9724"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1641 N MILWAUKEE AVE",
            "city": "LIBERTYVILLE",
            "state": "IL",
            "postal_code": "600481350",
            "telephone_number": "773-332-7692",
            "fax_number": "847-816-9724"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRIOLA",
        "first_name": "VICTORIA",
        "name_prefix": "Dr.",
        "credential": "PSYD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-02-08",
        "last_updated": "2015-01-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "071006158",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF ILLINOIS PROVIDER",
            "identifier": "01635735",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Libertyville, IL

Sources for this page

Verify at the official NPI Registry.