Provider Demographics
NPI:1194471854
Name:VILLANUEVA, MARIA V
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:V
Last Name:VILLANUEVA
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 1:2512 SW 14TH AVE APT 507
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33315-2257
Mailing Address - Country:US
Mailing Address - Phone:786-412-0416
Mailing Address - Fax:
Practice Address - Street 1:1333 S UNIVERSITY DR STE 206
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-4001
Practice Address - Country:US
Practice Address - Phone:786-412-0416
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-22
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health