MEDICARE: KHARLAJOY VILLANUEVA

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	SWIA.SC.61380582	WA

General Provider Information

NPI Number	:	1952277451
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KHARLAJOY VILLANUEVA

Provider Business Mailing Address
First Line	:	13223 SE 256TH ST APT G4
Second Line	:
City	:	KENT
State	:	WA
Zip	:	98042-6646
Country	:	US
Telephone Number	:	206-228-9411
Fax Number	:

Provider Business Practice Location Address
First Line	:	12360 LAKE CITY WAY NE STE 100
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98125-5447
Country	:	US
Telephone Number	:	206-695-3200
Fax Number	:

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

Provider Enumeration Date	:	10/13/2025
Last Update Date	:	10/13/2025

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