Provider Demographics
NPI:1093022816
Name:VALDIVIESO, GLORIA N (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:GLORIA
Middle Name:N
Last Name:VALDIVIESO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2807 KINSINGTON CIR
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33332-1863
Mailing Address - Country:US
Mailing Address - Phone:786-246-4848
Mailing Address - Fax:
Practice Address - Street 1:2863 EXECUTIVE PARK DR 106
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33331-3647
Practice Address - Country:US
Practice Address - Phone:954-358-5788
Practice Address - Fax:954-358-5790
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-01
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW100011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical