Provider Demographics
NPI:1538299904
Name:VILLAVICENCIO, ANNA LETICIA (PHD)
Entity Type:Individual
Prefix:DR
First Name:ANNA
Middle Name:LETICIA
Last Name:VILLAVICENCIO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:519 9TH ST SE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20003-2839
Mailing Address - Country:US
Mailing Address - Phone:202-735-3625
Mailing Address - Fax:
Practice Address - Street 1:519 9TH ST SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20003-2839
Practice Address - Country:US
Practice Address - Phone:202-735-3625
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2023-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPS01198103T00000X
WAPY60684527103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAPY60684527OtherPSYCHOLOGIST LICENSE
RIPS01198OtherPS01198