Provider Demographics
NPI:1093299422
Name:VILLEGAS, LUIS MANUEL (MCSW)
Entity Type:Individual
Prefix:MR
First Name:LUIS
Middle Name:MANUEL
Last Name:VILLEGAS
Suffix:
Gender:M
Credentials:MCSW
Other - Prefix:PROF
Other - First Name:LUIS
Other - Middle Name:M
Other - Last Name:VILLEGAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:SOCIAL WORKER CLINIC
Mailing Address - Street 1:22 CALLE FLORIDIANO APT 2205
Mailing Address - Street 2:URB CHALETS DE LA FUENTE
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00987
Mailing Address - Country:US
Mailing Address - Phone:787-597-2736
Mailing Address - Fax:
Practice Address - Street 1:90 CALLE ANTONIO JIMENEZ LANDRAU
Practice Address - Street 2:SAN RAFAEL
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00985
Practice Address - Country:US
Practice Address - Phone:787-597-2736
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-21
Last Update Date:2019-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR97381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty