Provider Demographics
NPI:1407695422
Name:VILLALON SEGURA, DIANELIS (CBHCM)
Entity type:Individual
Prefix:
First Name:DIANELIS
Middle Name:
Last Name:VILLALON SEGURA
Suffix:
Gender:F
Credentials:CBHCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2953 W 80TH ST APT 204
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33018-3897
Mailing Address - Country:US
Mailing Address - Phone:786-519-5266
Mailing Address - Fax:
Practice Address - Street 1:2953 W 80TH ST APT 204
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33018-3897
Practice Address - Country:US
Practice Address - Phone:786-519-5266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-20
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer