Provider Demographics
NPI:1821806746
Name:VILLACORTA, KATRINA (DNP, PMHNP)
Entity type:Individual
Prefix:
First Name:KATRINA
Middle Name:
Last Name:VILLACORTA
Suffix:
Gender:
Credentials:DNP, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 CHOSIN FEW WAY APT 3443
Mailing Address - Street 2:
Mailing Address - City:BAYONNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07002-7271
Mailing Address - Country:US
Mailing Address - Phone:845-499-6186
Mailing Address - Fax:
Practice Address - Street 1:511 S ORANGE AVE # 2078
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07103-1342
Practice Address - Country:US
Practice Address - Phone:845-499-6186
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-23
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ15228200363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health