Provider Demographics
NPI:1124638952
Name:BERRIOS-WEBBE, VILMA RAQUEL (LCSW)
Entity type:Individual
Prefix:
First Name:VILMA
Middle Name:RAQUEL
Last Name:BERRIOS-WEBBE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:V
Other - Middle Name:RAQUEL
Other - Last Name:BERRIOS-WEBBE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:1 HARGROVE GRADE
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32137-5117
Mailing Address - Country:US
Mailing Address - Phone:386-643-3115
Mailing Address - Fax:
Practice Address - Street 1:1 HARGROVE GRADE STE 1A
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137-5116
Practice Address - Country:US
Practice Address - Phone:386-643-3115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-06
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW17445104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker