Provider Demographics
NPI:1659503753
Name:VILLALPANDO, MICHELE ANNE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MICHELE
Middle Name:ANNE
Last Name:VILLALPANDO
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 1:641 BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:MC KEES ROCKS
Mailing Address - State:PA
Mailing Address - Zip Code:15136-3030
Mailing Address - Country:US
Mailing Address - Phone:412-445-1350
Mailing Address - Fax:412-331-2886
Practice Address - Street 1:641 BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:MC KEES ROCKS
Practice Address - State:PA
Practice Address - Zip Code:15136-3030
Practice Address - Country:US
Practice Address - Phone:412-445-1350
Practice Address - Fax:412-331-2886
Is Sole Proprietor?:No
Enumeration Date:2009-08-23
Last Update Date:2009-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0163361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA73-164113OtherTAX ID