Healthcare Provider Details

I. General information

NPI: 1316145105
Provider Name (Legal Business Name): VANESSA MARIA VILLAFANE GREGORY PH.D., M.P.H.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2007
Last Update Date: 01/02/2024
Certification Date: 01/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE 24 BLOQUE 49 NUMERO 44 VILLA CAROLINA
CAROLINA PR
00988
US

IV. Provider business mailing address

PO BOX 9801
CAROLINA PR
00988-9801
US

V. Phone/Fax

Practice location:
  • Phone: 787-550-1830
  • Fax:
Mailing address:
  • Phone: 787-550-1830
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH10528
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMT3380
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number1357
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: