Provider Demographics
NPI:1639413412
Name:PEREZ-VILLLANUEVA, MAGDALENA (PHD)
Entity Type:Individual
Prefix:DR
First Name:MAGDALENA
Middle Name:
Last Name:PEREZ-VILLLANUEVA
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 1:1024 PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60120-2934
Mailing Address - Country:US
Mailing Address - Phone:847-754-6337
Mailing Address - Fax:
Practice Address - Street 1:1920 THOREAU DR N
Practice Address - Street 2:
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60173-4176
Practice Address - Country:US
Practice Address - Phone:847-303-1880
Practice Address - Fax:847-303-1881
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-19
Last Update Date:2012-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.007870103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical