Provider Demographics
NPI:1831364488
Name:DIAZ DE VILLEGAS, LOURDES (LMSW)
Entity type:Individual
Prefix:
First Name:LOURDES
Middle Name:
Last Name:DIAZ DE VILLEGAS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2410 AMSTERDAM AVE
Mailing Address - Street 2:4 TH FL
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10033-7320
Mailing Address - Country:US
Mailing Address - Phone:212-740-1960
Mailing Address - Fax:917-258-3681
Practice Address - Street 1:2410 AMSTERDAM AVE
Practice Address - Street 2:4 TH FL
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10033-7320
Practice Address - Country:US
Practice Address - Phone:212-740-1960
Practice Address - Fax:917-258-3681
Is Sole Proprietor?:No
Enumeration Date:2008-04-24
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY072568104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY072568OtherLICENSE