Provider Demographics
NPI:1174862882
Name:VILLAR, REBECCA C (PSYD)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:C
Last Name:VILLAR
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 1:1355 S INTERNATIONAL PKWY
Mailing Address - Street 2:STE 2471
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-1694
Mailing Address - Country:US
Mailing Address - Phone:407-906-8843
Mailing Address - Fax:888-335-7778
Practice Address - Street 1:1355 S INTERNATIONAL PKWY
Practice Address - Street 2:STE 2471
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-1694
Practice Address - Country:US
Practice Address - Phone:407-906-8843
Practice Address - Fax:888-335-7778
Is Sole Proprietor?:No
Enumeration Date:2013-02-01
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 8696103T00000X
FLPY8696103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLGY029ZMedicare PIN