MEDICARE: LUISA VILLAMAR PSYCH

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	103TC1900X	Counseling Psychologist
2	103T00000X	Psychologist
3	390200000X	Student in an Organized Health Care Education/Training Program
4	101YP1600X	Pastoral Counselor

General Provider Information

NPI Number	:	1417743683
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUISA VILLAMAR PSYCH

Provider Business Mailing Address
First Line	:	1372 SUMMER ST STE 2
Second Line	:
City	:	STAMFORD
State	:	CT
Zip	:	06905-5366
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1372 SUMMER ST STE 2
Second Line	:
City	:	STAMFORD
State	:	CT
Zip	:	06905-5366
Country	:	US
Telephone Number	:	--
Fax Number	:

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

Provider Enumeration Date	:	04/15/2025
Last Update Date	:	01/15/2026

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