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NPI Code Detail

MEDICARE: DEANNA VILLAGRAN LPC, MT-BC

MEDICARE: DEANNA VILLAGRAN LPC, MT-BC
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
1101YP2500XProfessional CounselorPC008824PA

General Provider Information

NPI Number : 1497105159
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEANNA VILLAGRAN LPC, MT-BC
Provider Business Mailing Address
First Line : 7811 GERMANTOWN AVE
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19118-3526
Country : US
Telephone Number : 267-428-7850
Fax Number :
Provider Business Practice Location Address
First Line : 7811 GERMANTOWN AVE
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19118-3526
Country : US
Telephone Number : 267-428-7850
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/14/2016
Last Update Date : 06/14/2016

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