Provider Demographics
NPI:1255139069
Name:VILLANUEVA, ELENA (LMSW)
Entity type:Individual
Prefix:
First Name:ELENA
Middle Name:
Last Name:VILLANUEVA
Suffix:
Gender:
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 678
Mailing Address - Street 2:
Mailing Address - City:EMMETT
Mailing Address - State:ID
Mailing Address - Zip Code:83617-0678
Mailing Address - Country:US
Mailing Address - Phone:208-365-3437
Mailing Address - Fax:208-365-7235
Practice Address - Street 1:PO BOX 678
Practice Address - Street 2:
Practice Address - City:EMMETT
Practice Address - State:ID
Practice Address - Zip Code:83617-0678
Practice Address - Country:US
Practice Address - Phone:208-365-3437
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-06
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID50616781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical