Provider Demographics
NPI:1912182320
Name:VILLANUEVA, SHERRY LOUISE
Entity Type:Individual
Prefix:MRS
First Name:SHERRY
Middle Name:LOUISE
Last Name:VILLANUEVA
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:SHARON
Other - Middle Name:LOUISE
Other - Last Name:WOODS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 16
Mailing Address - Street 2:
Mailing Address - City:MONROVIA
Mailing Address - State:CA
Mailing Address - Zip Code:91017-0016
Mailing Address - Country:US
Mailing Address - Phone:626-217-2281
Mailing Address - Fax:
Practice Address - Street 1:50 W LEMON AVE
Practice Address - Street 2:SUITE 30
Practice Address - City:MONROVIA
Practice Address - State:CA
Practice Address - Zip Code:91016-6153
Practice Address - Country:US
Practice Address - Phone:626-217-2281
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-03
Last Update Date:2014-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 52798106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist