Provider Demographics
NPI:1639503352
Name:VALADAO, NICOLE (LMFT, RN)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:VALADAO
Suffix:
Gender:F
Credentials:LMFT, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2625 F COFFEE RD # 132
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-2053
Mailing Address - Country:US
Mailing Address - Phone:209-324-8440
Mailing Address - Fax:
Practice Address - Street 1:2625 F COFFEE RD # 132
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-2053
Practice Address - Country:US
Practice Address - Phone:209-324-8440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-29
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA63917101YP2500X
CA102273106H00000X
CA1022403163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA102273OtherBBS