Provider Demographics
NPI:1003051053
Name:VALENTINE, CINDA LOUISE (LISW)
Entity Type:Individual
Prefix:
First Name:CINDA
Middle Name:LOUISE
Last Name:VALENTINE
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 SWIRE HEIGHTS DR
Mailing Address - Street 2:
Mailing Address - City:AZTEC
Mailing Address - State:NM
Mailing Address - Zip Code:87410-3107
Mailing Address - Country:US
Mailing Address - Phone:505-947-6911
Mailing Address - Fax:
Practice Address - Street 1:201 SWIRE HEIGHTS DR
Practice Address - Street 2:
Practice Address - City:AZTEC
Practice Address - State:NM
Practice Address - Zip Code:87410-3107
Practice Address - Country:US
Practice Address - Phone:505-947-6911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-04
Last Update Date:2015-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-074871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMI-07457OtherNEW MIXICO BOARD OF SOCIAL WORK EXAMINERS
NM04135237Medicaid
NMM-06855OtherLMSW