Provider Demographics
NPI:1083954903
Name:DELVALLE, MARIE (SPECIAL EDUCATOR)
Entity Type:Individual
Prefix:MS
First Name:MARIE
Middle Name:
Last Name:DELVALLE
Suffix:
Gender:F
Credentials:SPECIAL EDUCATOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:490 MACDONOUGH ST
Mailing Address - Street 2:APT. 2
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11233-1510
Mailing Address - Country:US
Mailing Address - Phone:917-743-1126
Mailing Address - Fax:
Practice Address - Street 1:490 MACDONOUGH ST
Practice Address - Street 2:APT. 2
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11233-1510
Practice Address - Country:US
Practice Address - Phone:917-743-1126
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-01
Last Update Date:2013-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY850875174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist