Provider Demographics
NPI:1871310730
Name:HERNANDEZ-VILLAGRAN, MICHELLE MARIA (LCSW, LISW)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:MARIA
Last Name:HERNANDEZ-VILLAGRAN
Suffix:
Gender:F
Credentials:LCSW, LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 ALIENTO
Mailing Address - Street 2:
Mailing Address - City:RANCHO SANTA MARGARITA
Mailing Address - State:CA
Mailing Address - Zip Code:92688-1128
Mailing Address - Country:US
Mailing Address - Phone:949-272-6622
Mailing Address - Fax:
Practice Address - Street 1:3200 INGERSOLL AVE STE E
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50312-3917
Practice Address - Country:US
Practice Address - Phone:515-705-0174
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-23
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1241891041C0700X
IA1283001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical