MEDICARE: MONICA T VILLA 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	1041S0200X	School Social Worker	M-08131	NM
2	104100000X	Social Worker	SWB-2023-0576	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1447894449
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MONICA T VILLA LCSW

Provider Business Mailing Address
First Line	:	117 CAMINO DE VIDA STE 300
Second Line	:
City	:	SANTA ROSA
State	:	NM
Zip	:	88435-2267
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2020 7TH ST
Second Line	:
City	:	LAS VEGAS
State	:	NM
Zip	:	87701-4958
Country	:	US
Telephone Number	:	505-330-0830
Fax Number	:

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

Provider Enumeration Date	:	11/01/2019
Last Update Date	:	11/16/2023

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Directions to “ MONICA T VILLA LCSW” Practice Location

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