Provider Demographics
NPI:1508081670
Name:VILLAFANE, BERNARDINO SR (LCSW)
Entity Type:Individual
Prefix:
First Name:BERNARDINO
Middle Name:
Last Name:VILLAFANE
Suffix:SR
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 MARION CT
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:NY
Mailing Address - Zip Code:10970-2634
Mailing Address - Country:US
Mailing Address - Phone:917-627-3761
Mailing Address - Fax:845-290-6455
Practice Address - Street 1:19 W 34TH ST
Practice Address - Street 2:SUITE 1021
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-3006
Practice Address - Country:US
Practice Address - Phone:917-627-3761
Practice Address - Fax:845-290-6455
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0576521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical