Provider Demographics
NPI:1194142737
Name:ESPINO-VILLEGAS, MARIA (LICSW)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:ESPINO-VILLEGAS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:
Other - Last Name:VILLEGAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4780 32ND AVE S APT 114
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98118-2304
Mailing Address - Country:US
Mailing Address - Phone:509-251-1428
Mailing Address - Fax:213-482-6408
Practice Address - Street 1:1660 S COLUMBIAN WAY
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98108-1532
Practice Address - Country:US
Practice Address - Phone:206-762-1010
Practice Address - Fax:213-482-6408
Is Sole Proprietor?:No
Enumeration Date:2014-03-20
Last Update Date:2024-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW614947531041C0700X
171M00000X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program