Provider Demographics
NPI:1356069371
Name:VILLAGOMEZ, MARIA (MA)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:VILLAGOMEZ
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6815 W 63RD ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60638-4048
Mailing Address - Country:US
Mailing Address - Phone:708-304-3010
Mailing Address - Fax:708-575-5333
Practice Address - Street 1:6815 W 63RD ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60638-4048
Practice Address - Country:US
Practice Address - Phone:708-304-3010
Practice Address - Fax:708-575-5333
Is Sole Proprietor?:No
Enumeration Date:2022-08-16
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional