Provider Demographics
NPI:1306239553
Name:VILLAR NEUROPSYCHOLOGY, LLC
Entity type:Organization
Organization Name:VILLAR NEUROPSYCHOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NEUROPSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:C
Authorized Official - Last Name:VILLAR
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:407-906-8843
Mailing Address - Street 1:PO BOX 941652
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32794-1652
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1301 S INTERNATIONAL PKWY
Practice Address - Street 2:SUITE 2021
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-1409
Practice Address - Country:US
Practice Address - Phone:407-906-8843
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-12
Last Update Date:2015-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY8696103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GY029ZMedicare PIN