Provider Demographics
NPI:1275587412
Name:VALLADARES, MARIANNE S (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:MARIANNE
Middle Name:S
Last Name:VALLADARES
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 W WILCOX DR
Mailing Address - Street 2:STE 202
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635-1790
Mailing Address - Country:US
Mailing Address - Phone:520-249-7650
Mailing Address - Fax:
Practice Address - Street 1:300 EAST HOSPITAL RD.
Practice Address - Street 2:
Practice Address - City:FORT GORDON
Practice Address - State:GA
Practice Address - Zip Code:30905-5650
Practice Address - Country:US
Practice Address - Phone:706-787-6084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-20
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW109481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZLCSW10948OtherAZ BOARD OF BH