MEDICARE: RONALD VILLANO MENTAL HEALTH COUNSELOR, PLLC

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	101YM0800X	Mental Health Counselor	0035021	NY

General Provider Information

NPI Number	:	1720359086
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RONALD VILLANO MENTAL HEALTH COUNSELOR, PLLC

Provider Business Mailing Address
First Line	:	143 SYMPHONY DR
Second Line	:
City	:	LAKE GROVE
State	:	NY
Zip	:	11755-1316
Country	:	US
Telephone Number	:	631-758-8290
Fax Number	:	631-471-3878

Provider Business Practice Location Address
First Line	:	1650 SYCAMORE AVE
Second Line	:	SUITE 39
City	:	BOHEMIA
State	:	NY
Zip	:	11716-1738
Country	:	US
Telephone Number	:	631-758-8290
Fax Number	:	631-471-3878

Authorized Official
Title or Position	:	MEMBER
Name	:	MR. RONALD P VILLANO
Credential	:	MHC
Telephone Number	:	631-758-8290

Provider Enumeration Date	:	01/19/2012
Last Update Date	:	05/24/2012

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