Provider Demographics
NPI:1083458285
Name:VILLAREAL, MARIA R
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:R
Last Name:VILLAREAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3301 COORS BLVD NW # R180
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-1292
Mailing Address - Country:US
Mailing Address - Phone:505-652-4002
Mailing Address - Fax:888-899-5534
Practice Address - Street 1:3320 COORS BLVD NW STE C
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87120-1721
Practice Address - Country:US
Practice Address - Phone:505-652-4002
Practice Address - Fax:888-899-5534
Is Sole Proprietor?:No
Enumeration Date:2024-06-21
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMM-098721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical