Provider Demographics
NPI:1740380674
Name:VALLE VARELA, MARTHA D (FMD)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:D
Last Name:VALLE VARELA
Suffix:
Gender:F
Credentials:FMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4490 W 19TH CT
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-2831
Mailing Address - Country:US
Mailing Address - Phone:786-333-0077
Mailing Address - Fax:
Practice Address - Street 1:1665 W 68TH ST
Practice Address - Street 2:SUITE #201
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33014-4400
Practice Address - Country:US
Practice Address - Phone:786-773-3393
Practice Address - Fax:786-773-3394
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
FLMH14417101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst