Provider Demographics
NPI:1992938658
Name:VILLANUEVA, JOSE M SR (PHD)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:M
Last Name:VILLANUEVA
Suffix:SR
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:JOSE
Other - Middle Name:
Other - Last Name:VILLANUEVA
Other - Suffix:SR
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:CALLE 14
Mailing Address - Street 2:G105
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-6260
Mailing Address - Country:US
Mailing Address - Phone:787-789-8596
Mailing Address - Fax:787-276-8969
Practice Address - Street 1:VILLA NEVAREZ PROF. CENTER
Practice Address - Street 2:404 B
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00927
Practice Address - Country:US
Practice Address - Phone:787-960-1269
Practice Address - Fax:787-276-8969
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-28
Last Update Date:2009-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR138103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist