Provider Demographics
NPI:1083963342
Name:VALDEZ, MARINA (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARINA
Middle Name:
Last Name:VALDEZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1725 SE TENINO ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-6751
Mailing Address - Country:US
Mailing Address - Phone:971-231-5024
Mailing Address - Fax:
Practice Address - Street 1:1725 SE TENINO ST
Practice Address - Street 2:SUITE 203
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-6751
Practice Address - Country:US
Practice Address - Phone:971-231-5024
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-02
Last Update Date:2014-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2270103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling