Provider Demographics
NPI:1396358719
Name:VALLADARES, JORGE A (MA, MS)
Entity Type:Individual
Prefix:MR
First Name:JORGE
Middle Name:A
Last Name:VALLADARES
Suffix:
Gender:M
Credentials:MA, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3801 AVALON PARK EAST BLVD FL 2
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-4900
Mailing Address - Country:US
Mailing Address - Phone:407-795-2886
Mailing Address - Fax:
Practice Address - Street 1:3801 AVALON PARK EAST BLVD FL 2
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828-4900
Practice Address - Country:US
Practice Address - Phone:407-795-2886
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-25
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health