Provider Demographics
NPI:1598993644
Name:VILLA, MARYBELL (MA, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:MARYBELL
Middle Name:
Last Name:VILLA
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10927 124TH ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH OZONE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11420-1427
Mailing Address - Country:US
Mailing Address - Phone:917-669-3366
Mailing Address - Fax:718-554-6531
Practice Address - Street 1:10927 124TH ST
Practice Address - Street 2:
Practice Address - City:SOUTH OZONE PARK
Practice Address - State:NY
Practice Address - Zip Code:11420-1427
Practice Address - Country:US
Practice Address - Phone:917-669-3366
Practice Address - Fax:718-554-6531
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-29
Last Update Date:2009-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY8018-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist