Provider Demographics
NPI:1609062462
Name:VILLANO, RONALD (LMHC)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:
Last Name:VILLANO
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1650 SYCAMORE AVE
Mailing Address - Street 2:SUITE 39
Mailing Address - City:BOHEMIA
Mailing Address - State:NY
Mailing Address - Zip Code:11716-1738
Mailing Address - Country:US
Mailing Address - Phone:631-758-8290
Mailing Address - Fax:
Practice Address - Street 1:1650 SYCAMORE AVE
Practice Address - Street 2:SUITE 39
Practice Address - City:BOHEMIA
Practice Address - State:NY
Practice Address - Zip Code:11716-1738
Practice Address - Country:US
Practice Address - Phone:631-758-8290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-14
Last Update Date:2007-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003502-1101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional