Provider Demographics
NPI:1982813671
Name:VALENTIN, AIDA L (CAC REGISTERED CAND)
Entity Type:Individual
Prefix:
First Name:AIDA
Middle Name:L
Last Name:VALENTIN
Suffix:
Gender:F
Credentials:CAC REGISTERED CAND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 CRESCENT ST
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02302-3104
Mailing Address - Country:US
Mailing Address - Phone:508-941-0005
Mailing Address - Fax:508-427-6915
Practice Address - Street 1:142 CRESCENT ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02302-3104
Practice Address - Country:US
Practice Address - Phone:508-941-0005
Practice Address - Fax:508-427-6915
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)