MEDICARE: NICOLE DENISE VILLEGAS 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	67700	TX

General Provider Information

NPI Number	:	1114749876
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE DENISE VILLEGAS LCSW

Provider Business Mailing Address
First Line	:	509 GRAND CANYON ST
Second Line	:
City	:	EDINBURG
State	:	TX
Zip	:	78541-0776
Country	:	US
Telephone Number	:	956-648-4676
Fax Number	:

Provider Business Practice Location Address
First Line	:	1409 S 9TH AVE STE 131
Second Line	:
City	:	EDINBURG
State	:	TX
Zip	:	78539-5549
Country	:	US
Telephone Number	:	956-648-4676
Fax Number	:

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

Provider Enumeration Date	:	10/24/2024
Last Update Date	:	05/11/2026

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