Healthcare Provider Details

I. General information

NPI: 1417743683
Provider Name (Legal Business Name): LUISA VILLAMAR PSYCH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2025
Last Update Date: 04/15/2025
Certification Date: 04/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1372 SUMMER ST STE 2
STAMFORD CT
06905-5366
US

IV. Provider business mailing address

1372 SUMMER ST STE 2
STAMFORD CT
06905-5366
US

V. Phone/Fax

Practice location:
  • Phone: 959-210-6658
  • Fax:
Mailing address:
  • Phone: 347-514-9594
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: