MEDICARE: DANIEL VILLARREAL LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	7251	WI

General Provider Information

NPI Number	:	1053516013
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL VILLARREAL LCSW

Provider Business Mailing Address
First Line	:	860 GARDEN DR APT 73
Second Line	:
City	:	SUN PRAIRIE
State	:	WI
Zip	:	53590-4178
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	722 LOIS DR
Second Line	:
City	:	SUN PRAIRIE
State	:	WI
Zip	:	53590-1100
Country	:	US
Telephone Number	:	608-837-9112
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/19/2007
Last Update Date	:	03/09/2020

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