Provider Demographics
NPI:1609886670
Name:VALDEZ-KAMINSKY, ETI ANDREW (MFT)
Entity Type:Individual
Prefix:MR
First Name:ETI
Middle Name:ANDREW
Last Name:VALDEZ-KAMINSKY
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2340 WARD ST
Mailing Address - Street 2:#107
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-1124
Mailing Address - Country:US
Mailing Address - Phone:510-848-4900
Mailing Address - Fax:510-848-8365
Practice Address - Street 1:2340 WARD ST
Practice Address - Street 2:#107
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-1124
Practice Address - Country:US
Practice Address - Phone:510-848-4900
Practice Address - Fax:510-848-8365
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC37847106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC99535710OtherALAMEDA CO BEH HLTH SVCS
CAC99535710OtherMEDI CAL