Healthcare Provider Details

I. General information

NPI: 1194142737
Provider Name (Legal Business Name): MARIA ESPINO-VILLEGAS LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARIA VILLEGAS

II. Dates (important events)

Enumeration Date: 03/20/2014
Last Update Date: 12/26/2024
Certification Date: 12/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1660 S COLUMBIAN WAY
SEATTLE WA
98108-1532
US

IV. Provider business mailing address

4780 32ND AVE S APT 114
SEATTLE WA
98118-2304
US

V. Phone/Fax

Practice location:
  • Phone: 206-762-1010
  • Fax: 213-482-6408
Mailing address:
  • Phone: 509-251-1428
  • Fax: 213-482-6408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLW61494753
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: