Healthcare Provider Details

I. General information

NPI: 1659313161
Provider Name (Legal Business Name): THERESA MARIE VILLANI L.C.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 KINDERKAMACK RD SUITE 200
RIVER EDGE NJ
07661-1941
US

IV. Provider business mailing address

115 DOREMUS AVE
RIDGEWOOD NJ
07450-4213
US

V. Phone/Fax

Practice location:
  • Phone: 201-441-9335
  • Fax: 201-441-9711
Mailing address:
  • Phone: 201-652-0455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC04584600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: