1356799134 NPI number — JESENIA VILLOLDO LMFT, LMHC

Table of content: JESENIA VILLOLDO LMFT, LMHC (NPI 1356799134)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356799134 NPI number — JESENIA VILLOLDO LMFT, LMHC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VILLOLDO
Provider First Name:
JESENIA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LMFT, LMHC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MALDONADO
Provider Other First Name:
JESENIA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1356799134
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/25/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2 PINE CONE DR UNIT 351766
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PALM COAST
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32137-8674
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
678-733-1405
Provider Business Mailing Address Fax Number:
954-344-8634

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2 PINE CONE DR UNIT 351766
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PALM COAST
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32137-8674
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
678-733-1405
Provider Business Practice Location Address Fax Number:
954-344-8634
Provider Enumeration Date:
06/02/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  MT4692 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X , with the licence number: MH22412 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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