Healthcare Provider Details

I. General information

NPI: 1720505035
Provider Name (Legal Business Name): CLAUDIA L. VILLAMIL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2017
Last Update Date: 08/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 MAIN ST STE 818
WORCESTER MA
01608-1604
US

IV. Provider business mailing address

115 WEST CHESTNUT STREET SUITE 101
BROCKTON MA
02301
US

V. Phone/Fax

Practice location:
  • Phone: 508-791-4976
  • Fax:
Mailing address:
  • Phone: 508-521-2287
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: