Provider Demographics
NPI:1962119198
Name:VILLATE, CARMEN GUZMAN (LCSW)
Entity type:Individual
Prefix:
First Name:CARMEN
Middle Name:GUZMAN
Last Name:VILLATE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CARMEN
Other - Middle Name:M
Other - Last Name:VILLATE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:8410 SANDY BEACH ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33634-1246
Mailing Address - Country:US
Mailing Address - Phone:813-720-9282
Mailing Address - Fax:
Practice Address - Street 1:8410 SANDY BEACH ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33634-1246
Practice Address - Country:US
Practice Address - Phone:813-720-9282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-27
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0038991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical