Provider Demographics
NPI:1861478919
Name:HUBER VILLANO, PATRICIA A (LCSW R)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:A
Last Name:HUBER VILLANO
Suffix:
Gender:F
Credentials:LCSW R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 TRIEBLE AVE STE 5
Mailing Address - Street 2:
Mailing Address - City:BALLSTON SPA
Mailing Address - State:NY
Mailing Address - Zip Code:12020-6027
Mailing Address - Country:US
Mailing Address - Phone:518-469-9887
Mailing Address - Fax:
Practice Address - Street 1:15 TRIEBLE AVE STE 5
Practice Address - Street 2:
Practice Address - City:BALLSTON SPA
Practice Address - State:NY
Practice Address - Zip Code:12020-6027
Practice Address - Country:US
Practice Address - Phone:518-469-9887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-21
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0694761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN32B81OtherBLUE CROSS
NY00412537001OtherBSNENY
11590586OtherCAQH
P78947Medicare UPIN
NYDD4214Medicare ID - Type Unspecified