Provider Demographics
NPI:1629373469
Name:VALLE, YEZENIA NATHALIE
Entity Type:Individual
Prefix:
First Name:YEZENIA
Middle Name:NATHALIE
Last Name:VALLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1350 N ORANGE AVE
Mailing Address - Street 2:SUITE 223
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-4945
Mailing Address - Country:US
Mailing Address - Phone:407-644-4367
Mailing Address - Fax:
Practice Address - Street 1:1350 N ORANGE AVE
Practice Address - Street 2:SUITE 223
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-4945
Practice Address - Country:US
Practice Address - Phone:407-644-4367
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-25
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL208376709OtherTAX IDENTIFICATION NUMBER