Provider Demographics
NPI:1942982681
Name:VILLA, MARIA ANGELICA (MA)
Entity Type:Individual
Prefix:MS
First Name:MARIA
Middle Name:ANGELICA
Last Name:VILLA
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:ANGELICA
Other - Last Name:VILLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MARIA VILLA
Mailing Address - Street 1:40 MADISON ST APT 5C
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10038-1234
Mailing Address - Country:US
Mailing Address - Phone:332-227-5646
Mailing Address - Fax:
Practice Address - Street 1:860 MELROSE AVE FRNT 2L
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10451-5757
Practice Address - Country:US
Practice Address - Phone:332-227-5646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-02
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2879141103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool