Provider Demographics
NPI:1396460853
Name:VILLACCI, LOUISE
Entity type:Individual
Prefix:MRS
First Name:LOUISE
Middle Name:
Last Name:VILLACCI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 MARCUS GARVEY BLVD STE 421
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11206-5303
Mailing Address - Country:US
Mailing Address - Phone:646-664-7378
Mailing Address - Fax:
Practice Address - Street 1:7 MARCUS GARVEY BLVD STE 421
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11206-5303
Practice Address - Country:US
Practice Address - Phone:646-664-7378
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-06
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator