Provider Demographics
NPI:1659903227
Name:VALLE, ELDIN
Entity Type:Individual
Prefix:MR
First Name:ELDIN
Middle Name:
Last Name:VALLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 LINLEW DR APT 15
Mailing Address - Street 2:
Mailing Address - City:DERRY
Mailing Address - State:NH
Mailing Address - Zip Code:03038-2916
Mailing Address - Country:US
Mailing Address - Phone:617-869-6582
Mailing Address - Fax:
Practice Address - Street 1:20 MARKET ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03101-1957
Practice Address - Country:US
Practice Address - Phone:603-622-4747
Practice Address - Fax:603-622-7328
Is Sole Proprietor?:No
Enumeration Date:2020-02-11
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)