Provider Demographics
NPI:1881034312
Name:VILLALOBOS, MYRIAM T (MED, MA)
Entity Type:Individual
Prefix:MRS
First Name:MYRIAM
Middle Name:T
Last Name:VILLALOBOS
Suffix:
Gender:F
Credentials:MED, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 HOWARD ST
Mailing Address - Street 2:
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01702-3242
Mailing Address - Country:US
Mailing Address - Phone:508-879-2250
Mailing Address - Fax:
Practice Address - Street 1:175 SOUTH ST
Practice Address - Street 2:
Practice Address - City:WALPOLE
Practice Address - State:MA
Practice Address - Zip Code:02081-3242
Practice Address - Country:US
Practice Address - Phone:508-341-6267
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-28
Last Update Date:2013-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health