Provider Demographics
NPI:1316585128
Name:VILLAGRAN, FLOR (LMHC)
Entity Type:Individual
Prefix:
First Name:FLOR
Middle Name:
Last Name:VILLAGRAN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:FLOR
Other - Middle Name:
Other - Last Name:VILLAGRAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMHC
Mailing Address - Street 1:3027 30TH ST FL 1
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11102-2261
Mailing Address - Country:US
Mailing Address - Phone:718-721-0330
Mailing Address - Fax:718-721-0355
Practice Address - Street 1:10324 CORONA AVE
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:NY
Practice Address - Zip Code:11368-3177
Practice Address - Country:US
Practice Address - Phone:929-522-0952
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-12
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP103221101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1316585128Medicaid