Individual
MRS. CARMEN VILLAVICENCIO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
4610 61ST ST, WOODSIDE, NY 11377-5766
(917) 291-1160
Mailing address
4610 61ST ST, WOODSIDE, NY 11377-5766
(917) 291-1160
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
079481
NY
Other
Enumeration date
09/29/2010
Last updated
11/09/2012
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