Provider Demographics
NPI:1689172181
Name:VALADEZ, RUDOLPH III
Entity Type:Individual
Prefix:
First Name:RUDOLPH
Middle Name:
Last Name:VALADEZ
Suffix:III
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 1:738 HALE ST
Mailing Address - Street 2:
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-2178
Mailing Address - Country:US
Mailing Address - Phone:915-497-5197
Mailing Address - Fax:
Practice Address - Street 1:41 MASON ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-2260
Practice Address - Country:US
Practice Address - Phone:978-746-1837
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-30
Last Update Date:2018-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health