Provider Demographics
NPI:1326605122
Name:VILLASENOR, DENISE GERALYN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:GERALYN
Last Name:VILLASENOR
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 DOUGLASS DRIVE
Mailing Address - Street 2:
Mailing Address - City:COTO DE CAZA
Mailing Address - State:CA
Mailing Address - Zip Code:92679
Mailing Address - Country:US
Mailing Address - Phone:949-374-1563
Mailing Address - Fax:
Practice Address - Street 1:23719 MOULTON PKWY
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-1913
Practice Address - Country:US
Practice Address - Phone:949-587-3700
Practice Address - Fax:949-462-0793
Is Sole Proprietor?:No
Enumeration Date:2019-05-28
Last Update Date:2019-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS153981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical