Provider Demographics
NPI:1649626912
Name:CARRASCAL VILLANUEVA, MARGIE VI
Entity type:Individual
Prefix:
First Name:MARGIE
Middle Name:
Last Name:CARRASCAL VILLANUEVA
Suffix:VI
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 1:2054 81ST AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94621-2310
Mailing Address - Country:US
Mailing Address - Phone:510-541-9286
Mailing Address - Fax:
Practice Address - Street 1:3450 3RD ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94124-1443
Practice Address - Country:US
Practice Address - Phone:415-680-8140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-05
Last Update Date:2016-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health