Healthcare Provider Details

I. General information

NPI: 1811292873
Provider Name (Legal Business Name): IVONNE MARIE VILLATE PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/21/2011
Last Update Date: 01/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

#20 PINEIRO SUITE 201
GUAYNABO PR
00969
US

IV. Provider business mailing address

AN35 PLAZA SAN VICENTE ANTILLANA
TRUJILLO ALTO PR
00976-6128
US

V. Phone/Fax

Practice location:
  • Phone: 787-790-6448
  • Fax:
Mailing address:
  • Phone: 787-644-5497
  • Fax: 787-790-6448

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1594
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: