1720359086 NPI number — RONALD VILLANO MENTAL HEALTH COUNSELOR, PLLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720359086 NPI number — RONALD VILLANO MENTAL HEALTH COUNSELOR, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RONALD VILLANO MENTAL HEALTH COUNSELOR, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1720359086
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/24/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
143 SYMPHONY DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAKE GROVE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11755-1316
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-758-8290
Provider Business Mailing Address Fax Number:
631-471-3878

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1650 SYCAMORE AVE
Provider Second Line Business Practice Location Address:
SUITE 39
Provider Business Practice Location Address City Name:
BOHEMIA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11716-1738
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-758-8290
Provider Business Practice Location Address Fax Number:
631-471-3878
Provider Enumeration Date:
01/19/2012

Additional Information

Authorized Official

Authorized Official Last Name:
VILLANO
Authorized Official First Name:
RONALD
Authorized Official Middle Name:
P
Authorized Official Title or Position:
MEMBER
Authorized Official Telephone Number:
631-758-8290

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  0035021 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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