Provider Demographics
NPI:1093528788
Name:VILLASENOR, VIRIDIANA (LAMFT)
Entity type:Individual
Prefix:
First Name:VIRIDIANA
Middle Name:
Last Name:VILLASENOR
Suffix:
Gender:F
Credentials:LAMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:83 PACIFIC ST APT 1
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07105-1490
Mailing Address - Country:US
Mailing Address - Phone:201-852-2830
Mailing Address - Fax:
Practice Address - Street 1:4551 ROUTE 42 STE 5
Practice Address - Street 2:
Practice Address - City:BLACKWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08012-1751
Practice Address - Country:US
Practice Address - Phone:856-271-4490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-28
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAMF000045106H00000X
NJ37FA00050300106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist