Healthcare Provider Details

I. General information

NPI: 1376122473
Provider Name (Legal Business Name): JOVANNA A VILLAMAN LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2021
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 N MAIN ST
PROVIDENCE RI
02904-5762
US

IV. Provider business mailing address

41 WALES ST
CRANSTON RI
02920-7232
US

V. Phone/Fax

Practice location:
  • Phone: 401-276-4100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMHC02091
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: