Provider Demographics
NPI:1649718420
Name:VILLAFANA, KADIJAH (LCSW)
Entity type:Individual
Prefix:
First Name:KADIJAH
Middle Name:
Last Name:VILLAFANA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KADIJAH
Other - Middle Name:
Other - Last Name:FUENTES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:608 FILBERT ST
Mailing Address - Street 2:
Mailing Address - City:ROSELLE PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07204-1333
Mailing Address - Country:US
Mailing Address - Phone:908-482-3648
Mailing Address - Fax:
Practice Address - Street 1:183 S ORANGE AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07103-2757
Practice Address - Country:US
Practice Address - Phone:973-972-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-01
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1041C0700X
NJ44SC062900001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical