Provider Demographics
NPI:1629546924
Name:VALENZUELA, CYSCY
Entity Type:Individual
Prefix:
First Name:CYSCY
Middle Name:
Last Name:VALENZUELA
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 1:9070 STEBBING WAY APT C
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20723-5961
Mailing Address - Country:US
Mailing Address - Phone:301-257-4062
Mailing Address - Fax:
Practice Address - Street 1:5268 NICHOLSON LN # 188G
Practice Address - Street 2:
Practice Address - City:KENSINGTON
Practice Address - State:MD
Practice Address - Zip Code:20895-1009
Practice Address - Country:US
Practice Address - Phone:571-317-1742
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-05
Last Update Date:2018-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician