Provider Demographics
NPI:1952529927
Name:DIANA L. VILLEGAS PH.D. LICSW
Entity type:Organization
Organization Name:DIANA L. VILLEGAS PH.D. LICSW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:L
Authorized Official - Last Name:VILLEGAS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD MSW
Authorized Official - Phone:978-266-2990
Mailing Address - Street 1:481 GREAT RD
Mailing Address - Street 2:STE 215
Mailing Address - City:ACTON
Mailing Address - State:MA
Mailing Address - Zip Code:01720-4157
Mailing Address - Country:US
Mailing Address - Phone:978-266-2990
Mailing Address - Fax:978-266-2990
Practice Address - Street 1:481 GREAT RD
Practice Address - Street 2:STE 215
Practice Address - City:ACTON
Practice Address - State:MA
Practice Address - Zip Code:01720-4157
Practice Address - Country:US
Practice Address - Phone:978-266-2990
Practice Address - Fax:978-266-2990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP04294OtherBC & BS OF MA
MAVI P04294Medicare ID - Type Unspecified