Provider Demographics
NPI:1346546058
Name:VILLASENOR, CARMEN LAURENA
Entity Type:Individual
Prefix:MS
First Name:CARMEN
Middle Name:LAURENA
Last Name:VILLASENOR
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 1:51-636 KAMEHAMEHA HWY
Mailing Address - Street 2:UNIT 323
Mailing Address - City:KAAAWA
Mailing Address - State:HI
Mailing Address - Zip Code:96730-9821
Mailing Address - Country:US
Mailing Address - Phone:317-363-3665
Mailing Address - Fax:
Practice Address - Street 1:51-636 KAMEHAMEHA HWY
Practice Address - Street 2:UNIT 323
Practice Address - City:KAAAWA
Practice Address - State:HI
Practice Address - Zip Code:96730-9821
Practice Address - Country:US
Practice Address - Phone:317-363-3665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-28
Last Update Date:2011-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health