Provider Demographics
NPI:1306272224
Name:VILLANUEVA, ELSIE L (SAC)
Entity type:Individual
Prefix:MRS
First Name:ELSIE
Middle Name:L
Last Name:VILLANUEVA
Suffix:
Gender:F
Credentials:SAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:GARDENIA ST. EXTENCION CAMPO ALEGRE
Mailing Address - Street 2:B 3
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00956
Mailing Address - Country:US
Mailing Address - Phone:787-349-8183
Mailing Address - Fax:
Practice Address - Street 1:654 CALLE JURIEL
Practice Address - Street 2:CIUDAD INTERAMERICANA
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956-6814
Practice Address - Country:US
Practice Address - Phone:787-349-8183
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-24
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1932101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)