Basic Information
| Provider Information | |||||||||
| NPI: | 1538526504 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VILLEGAS | ||||||||
| FirstName: | BEATRICE | ||||||||
| MiddleName: | ELAINE | ||||||||
| NamePrefix: | |||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1015 3RD ST SW | ||||||||
| Address2: | |||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871024133 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5052355327 | ||||||||
| FaxNumber: | 5052721538 | ||||||||
| Practice Location | |||||||||
| Address1: | 306 SAN PABLO ST SE | ||||||||
| Address2: | |||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871083167 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5054532744 | ||||||||
| FaxNumber: | 5052721538 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/21/2016 | ||||||||
| LastUpdateDate: | 07/09/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/09/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | M-09716 | NM | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | C-11564 | NM | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.