MEDICARE: BEATRICE ELAINE VILLEGAS LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	M-09716	NM
2	1041C0700X	Clinical Social Worker	C-11564	NM

General Provider Information

NPI Number	:	1538526504
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BEATRICE ELAINE VILLEGAS LCSW

Provider Business Mailing Address
First Line	:	1015 3RD ST SW
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87102-4133
Country	:	US
Telephone Number	:	505-235-5327
Fax Number	:	505-272-1538

Provider Business Practice Location Address
First Line	:	306 SAN PABLO ST SE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87108-3167
Country	:	US
Telephone Number	:	505-453-2744
Fax Number	:	505-272-1538

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/21/2016
Last Update Date	:	07/05/2023

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