Provider Demographics
NPI:1497385272
Name:DEL VALLE, ERNEST JR
Entity Type:Individual
Prefix:MR
First Name:ERNEST
Middle Name:
Last Name:DEL VALLE
Suffix:JR
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 1:325 SW 28TH ST
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33315-2612
Mailing Address - Country:US
Mailing Address - Phone:954-357-4839
Mailing Address - Fax:
Practice Address - Street 1:325 SW 28TH ST
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33315-2612
Practice Address - Country:US
Practice Address - Phone:954-357-4839
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-22
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)