Provider Demographics
NPI:1639616105
Name:VILASECA, AMANDA CHRISTINE (LCSW)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:CHRISTINE
Last Name:VILASECA
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 1:150 W 225TH ST APT 6D
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-5040
Mailing Address - Country:US
Mailing Address - Phone:646-651-3717
Mailing Address - Fax:
Practice Address - Street 1:1 NASSAU RD APT 4
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10710-1641
Practice Address - Country:US
Practice Address - Phone:646-651-3717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-23
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY099522104100000X
NY0908071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker