Individual
DR. JORGE OCTAVIO VILLELLA III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1 TRESCOTT PATH, NORTHPORT, NY 11768-2535
(631) 292-2404
Mailing address
1 TRESCOTT PATH, NORTHPORT, NY 11768-2535
(631) 292-2404
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
121894
NY
Other
Enumeration date
01/13/2013
Last updated
01/13/2013
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