Provider Demographics
NPI:1154098382
Name:VILLABRERA, MIRAFLORE JOSEPH
Entity type:Individual
Prefix:
First Name:MIRAFLORE
Middle Name:JOSEPH
Last Name:VILLABRERA
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 1:806 E 37TH ST FL 2
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210-1928
Mailing Address - Country:US
Mailing Address - Phone:917-402-8232
Mailing Address - Fax:
Practice Address - Street 1:806 E 37TH ST FL 2
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11210-1928
Practice Address - Country:US
Practice Address - Phone:917-402-8232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-25
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst