Provider Demographics
NPI:1578701017
Name:VILA, NELSON S
Entity Type:Individual
Prefix:MR
First Name:NELSON
Middle Name:S
Last Name:VILA
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:NELSON
Other - Middle Name:S
Other - Last Name:VILA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMSW
Mailing Address - Street 1:2432 GRAND CONCOURSE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10458-5204
Mailing Address - Country:US
Mailing Address - Phone:718-817-7060
Mailing Address - Fax:718-817-7067
Practice Address - Street 1:2432 GRAND CONCOURSE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10458-5204
Practice Address - Country:US
Practice Address - Phone:718-817-7060
Practice Address - Fax:718-817-7067
Is Sole Proprietor?:No
Enumeration Date:2009-01-21
Last Update Date:2009-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY044082-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical