Provider Demographics
NPI:1720359086
Name:RONALD VILLANO MENTAL HEALTH COUNSELOR, PLLC
Entity Type:Organization
Organization Name:RONALD VILLANO MENTAL HEALTH COUNSELOR, PLLC
Other - Org Name:FAMILY & PERSONAL COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:P
Authorized Official - Last Name:VILLANO
Authorized Official - Suffix:
Authorized Official - Credentials:MHC
Authorized Official - Phone:631-758-8290
Mailing Address - Street 1:143 SYMPHONY DR
Mailing Address - Street 2:
Mailing Address - City:LAKE GROVE
Mailing Address - State:NY
Mailing Address - Zip Code:11755-1316
Mailing Address - Country:US
Mailing Address - Phone:631-758-8290
Mailing Address - Fax:631-471-3878
Practice Address - Street 1:1650 SYCAMORE AVE
Practice Address - Street 2:SUITE 39
Practice Address - City:BOHEMIA
Practice Address - State:NY
Practice Address - Zip Code:11716-1738
Practice Address - Country:US
Practice Address - Phone:631-758-8290
Practice Address - Fax:631-471-3878
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-19
Last Update Date:2012-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0035021101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty