Provider Demographics
NPI:1699875948
Name:VILLANO, CHERIE LYNN (PSYD)
Entity type:Individual
Prefix:
First Name:CHERIE
Middle Name:LYNN
Last Name:VILLANO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1825 FOSTER AVE
Mailing Address - Street 2:#6D
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-1834
Mailing Address - Country:US
Mailing Address - Phone:718-421-5022
Mailing Address - Fax:
Practice Address - Street 1:250 WEST 57TH ST.
Practice Address - Street 2:STE. 501
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019
Practice Address - Country:US
Practice Address - Phone:917-446-3157
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016259103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYVM7641Medicare ID - Type Unspecified