Provider Demographics
NPI:1841945946
Name:VILLACIS, CATHY LUANNE (MED)
Entity type:Individual
Prefix:MS
First Name:CATHY
Middle Name:LUANNE
Last Name:VILLACIS
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 CHESAPEAKE ST
Mailing Address - Street 2:
Mailing Address - City:LYNDORA
Mailing Address - State:PA
Mailing Address - Zip Code:16045-1148
Mailing Address - Country:US
Mailing Address - Phone:724-282-2441
Mailing Address - Fax:
Practice Address - Street 1:6 CHESAPEAKE ST STE 103
Practice Address - Street 2:
Practice Address - City:LYNDORA
Practice Address - State:PA
Practice Address - Zip Code:16045-1149
Practice Address - Country:US
Practice Address - Phone:724-282-2441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-16
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst