Provider Demographics
NPI:1710325824
Name:VILLAFUERTE, JOSE (LCSW, LMSW)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:
Last Name:VILLAFUERTE
Suffix:
Gender:M
Credentials:LCSW, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:628 GEORGE ST
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-5362
Mailing Address - Country:US
Mailing Address - Phone:475-422-1819
Mailing Address - Fax:
Practice Address - Street 1:628 GEORGE ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-5362
Practice Address - Country:US
Practice Address - Phone:475-422-1819
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-11
Last Update Date:2014-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
CT87771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor