Provider Demographics
NPI:1083683197
Name:VALENCIA, MANUEL S (MD)
Entity Type:Individual
Prefix:DR
First Name:MANUEL
Middle Name:S
Last Name:VALENCIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:83 BALDPATE RD
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:MA
Mailing Address - Zip Code:01833-2303
Mailing Address - Country:US
Mailing Address - Phone:978-353-2131
Mailing Address - Fax:978-352-6755
Practice Address - Street 1:83 BALDPATE RD
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:MA
Practice Address - Zip Code:01833-2303
Practice Address - Country:US
Practice Address - Phone:978-353-2131
Practice Address - Fax:978-352-6755
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2042792084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0191931Medicaid
MA0191931Medicaid
MAA33705Medicare ID - Type Unspecified