Provider Demographics
NPI:1417542960
Name:GLADYSLENE VILLALONGA PSYCHIATRIC CONSULTATION LLC
Entity Type:Organization
Organization Name:GLADYSLENE VILLALONGA PSYCHIATRIC CONSULTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PMHNP, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GLADYSLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:VILLALONGA
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, PMHNP-BC
Authorized Official - Phone:786-499-2154
Mailing Address - Street 1:27502 SW 134TH CT
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33032-8291
Mailing Address - Country:US
Mailing Address - Phone:786-499-2154
Mailing Address - Fax:
Practice Address - Street 1:27502 SW 134TH CT
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33032-8291
Practice Address - Country:US
Practice Address - Phone:786-499-2154
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-06
Last Update Date:2021-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)