Provider Demographics
NPI:1508310822
Name:VALCY, MIKE (MA, LMT#82541)
Entity Type:Individual
Prefix:
First Name:MIKE
Middle Name:
Last Name:VALCY
Suffix:
Gender:M
Credentials:MA, LMT#82541
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 SEMINOLE DR
Mailing Address - Street 2:106
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33304-3201
Mailing Address - Country:US
Mailing Address - Phone:954-604-1212
Mailing Address - Fax:
Practice Address - Street 1:1010 SEMINOLE DR
Practice Address - Street 2:106
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33304-3201
Practice Address - Country:US
Practice Address - Phone:954-604-1212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-04
Last Update Date:2016-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLLMT 82541172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0OtherAFFORDABLE CARE ACT