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General NPI Number Information
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NPI Number | 1366166563
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Entity Type | Individual
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Provider Name | MR. HERTZEN VILELA
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Gender | Male
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Dates
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Enumeration Date | 09/30/2022
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Last Update Date | 09/30/2022
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Provider Practice Location Address
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Address Line | 2825 3RD AVE STE 402
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City | BRONX
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State | NY
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Zip | 10455-4066
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Country | US
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Telephone | 585-709-8319
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Fax |
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Provider Business Mailing Address
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Address Line | 21 W END AVE APT 2510
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City | NEW YORK
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State | NY
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Zip | 10023-7987
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Country | US
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Telephone | 917-922-2245
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 009962
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License Number State | NY
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