Provider Demographics
NPI:1376673426
Name:VILCAPOMA, ABEL (DMIN)
Entity Type:Individual
Prefix:DR
First Name:ABEL
Middle Name:
Last Name:VILCAPOMA
Suffix:
Gender:M
Credentials:DMIN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 JAQUES AVE # 1
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01610-1149
Mailing Address - Country:US
Mailing Address - Phone:508-799-9909
Mailing Address - Fax:508-795-1338
Practice Address - Street 1:275 BELMONT ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01604-1675
Practice Address - Country:US
Practice Address - Phone:508-421-4506
Practice Address - Fax:508-795-1338
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA101YM0800XOtherMENTAL HEALTH