Provider Demographics
NPI:1164035499
Name:VILLACIS, STEFANIA
Entity Type:Individual
Prefix:
First Name:STEFANIA
Middle Name:
Last Name:VILLACIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14449 BRUSHWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-5374
Mailing Address - Country:US
Mailing Address - Phone:407-990-0060
Mailing Address - Fax:
Practice Address - Street 1:14449 BRUSHWOOD WAY
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-5374
Practice Address - Country:US
Practice Address - Phone:407-990-0060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-26
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMT3362101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health