Provider Demographics
NPI:1750190401
Name:VILLEGAS, BENJAMIN ABDIEL
Entity type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:ABDIEL
Last Name:VILLEGAS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CARR 19 CONDOMINIO CAMINO REAL 1500
Mailing Address - Street 2:APT E-103
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00966-0000
Mailing Address - Country:US
Mailing Address - Phone:787-445-0101
Mailing Address - Fax:
Practice Address - Street 1:CARR 19 CONDOMINIO CAMINO REAL 1500
Practice Address - Street 2:APT E-103
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00966-0000
Practice Address - Country:US
Practice Address - Phone:787-445-0101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-06
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8322103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchoolGroup - Single Specialty