Provider Demographics
NPI:1376083246
Name:VILLARREAL, ROSEMARIE (LMSW)
Entity Type:Individual
Prefix:
First Name:ROSEMARIE
Middle Name:
Last Name:VILLARREAL
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1229 WOODHAVEN DR APT 6
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48327-4219
Mailing Address - Country:US
Mailing Address - Phone:248-636-5184
Mailing Address - Fax:
Practice Address - Street 1:4480 ELMDALE AVE
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48346
Practice Address - Country:US
Practice Address - Phone:248-636-5184
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-27
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010996811041C0700X
MI68011164571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical