Provider Demographics
NPI:1821396300
Name:VALADES-FLYNN, CATHY ALBERTA (MSW, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:CATHY
Middle Name:ALBERTA
Last Name:VALADES-FLYNN
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1661 COUGHLIN ST
Mailing Address - Street 2:
Mailing Address - City:LARAMIE
Mailing Address - State:WY
Mailing Address - Zip Code:82072-2321
Mailing Address - Country:US
Mailing Address - Phone:307-760-9396
Mailing Address - Fax:
Practice Address - Street 1:204 MCCOLLUM DR
Practice Address - Street 2:SUITE 106
Practice Address - City:LARAMIE
Practice Address - State:WY
Practice Address - Zip Code:82070-5103
Practice Address - Country:US
Practice Address - Phone:307-721-2827
Practice Address - Fax:307-742-0361
Is Sole Proprietor?:No
Enumeration Date:2011-03-07
Last Update Date:2011-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYLCSW-0481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY1184777625Medicaid