Provider Demographics
NPI:1316145105
Name:VILLAFANE GREGORY, VANESSA MARIA (PHD, MPH)
Entity type:Individual
Prefix:DR
First Name:VANESSA
Middle Name:MARIA
Last Name:VILLAFANE GREGORY
Suffix:
Gender:F
Credentials:PHD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9801
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00988-9801
Mailing Address - Country:US
Mailing Address - Phone:787-550-1830
Mailing Address - Fax:
Practice Address - Street 1:CALLE 24 BLOQUE 49 NUMERO 44 VILLA CAROLINA
Practice Address - Street 2:
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00988
Practice Address - Country:US
Practice Address - Phone:787-550-1830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-03
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH10528101YM0800X
FLMT3380106H00000X
PR1357103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist