Provider Demographics
NPI:1811292873
Name:VILLATE, IVONNE MARIE (PSYD)
Entity type:Individual
Prefix:
First Name:IVONNE
Middle Name:MARIE
Last Name:VILLATE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:AN35 PLAZA SAN VICENTE
Mailing Address - Street 2:ANTILLANA
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00976-6128
Mailing Address - Country:US
Mailing Address - Phone:787-644-5497
Mailing Address - Fax:787-790-6448
Practice Address - Street 1:#20 PINEIRO
Practice Address - Street 2:SUITE 201
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969
Practice Address - Country:US
Practice Address - Phone:787-790-6448
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-21
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1594103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical