Provider Demographics
NPI:1518415496
Name:VILLA ALICEA, JESSICA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:
Last Name:VILLA ALICEA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:MUNIZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1 MANCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10710-4407
Mailing Address - Country:US
Mailing Address - Phone:914-774-6225
Mailing Address - Fax:
Practice Address - Street 1:98-120 QUEENS BLVD
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-3269
Practice Address - Country:US
Practice Address - Phone:718-504-9256
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-20
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY101703-1104100000X
NY0952601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1285628552Other1285628552