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Individual

MR. JUAN AMILCAR VILLALTA III

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PSYCHOLOGY ASSOCIATE

Contact information

Practice address
8229 CLOVERLEAF DR STE 425, MILLERSVILLE, MD 21108-1594
(301) 775-6714
(410) 987-0576
Mailing address
8229 CLOVERLEAF DR STE 425, MILLERSVILLE, MD 21108-1594
(301) 775-6714
(410) 987-0576

Taxonomy

Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
A0496
MD
103TS0200X
School Psychologist
CER87994B7B7L9
MD

Other

Enumeration date
10/16/2018
Last updated
10/29/2024
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