Provider Demographics
NPI:1437518073
Name:VALCIN, MARIO
Entity Type:Individual
Prefix:
First Name:MARIO
Middle Name:
Last Name:VALCIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20535 NW 2ND AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33169-2547
Mailing Address - Country:US
Mailing Address - Phone:059-003-4753
Mailing Address - Fax:
Practice Address - Street 1:20535 NW 2ND AVE STE 204
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33169-2547
Practice Address - Country:US
Practice Address - Phone:059-003-4753
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-10
Last Update Date:2024-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TB0200X, 171M00000X
FL25269101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No171M00000XOther Service ProvidersCase Manager/Care Coordinator