Healthcare Provider Details

I. General information

NPI: 1982965281
Provider Name (Legal Business Name): ANGEL A VILLARREAL SOCIAL WORK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2012
Last Update Date: 06/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

436 CAMINO DE GUANICA URB SABANERA DORADO
DORADO PR
00646-3636
US

IV. Provider business mailing address

436 CAMINO DE GUANICA URB SABANERA DORADO
DORADO PR
00646-3636
US

V. Phone/Fax

Practice location:
  • Phone: 718-710-6995
  • Fax:
Mailing address:
  • Phone: 718-710-6995
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR057653
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number9819
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: