Provider Demographics
NPI:1891094918
Name:VALDEZ, SELENE A (LCSW)
Entity Type:Individual
Prefix:
First Name:SELENE
Middle Name:A
Last Name:VALDEZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 US HWY 50
Mailing Address - Street 2:PO BOX 153
Mailing Address - City:AVONDALE
Mailing Address - State:CO
Mailing Address - Zip Code:81022
Mailing Address - Country:US
Mailing Address - Phone:719-566-0345
Mailing Address - Fax:
Practice Address - Street 1:4112 OUTLOOK BLVD
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81008-1667
Practice Address - Country:US
Practice Address - Phone:719-553-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-16
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO10891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical