Provider Demographics
NPI:1609411271
Name:VILLAFUERTE, GABRIELLE (LCSW)
Entity Type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:
Last Name:VILLAFUERTE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:923 VANCE JACKSON APT 1064
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78201-2750
Mailing Address - Country:US
Mailing Address - Phone:210-445-0444
Mailing Address - Fax:
Practice Address - Street 1:12500 NW MILITARY HWY STE 250
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78231-2000
Practice Address - Country:US
Practice Address - Phone:210-302-6920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-07
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX628551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX62855Medicaid