Provider Demographics
NPI:1518242387
Name:VALDES, DOMINIC PATRICK (LCSW)
Entity type:Individual
Prefix:MR
First Name:DOMINIC
Middle Name:PATRICK
Last Name:VALDES
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1480 VINE ST APT 701
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90028-8161
Mailing Address - Country:US
Mailing Address - Phone:213-549-3222
Mailing Address - Fax:
Practice Address - Street 1:1480 VINE ST APT 701
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90028-8161
Practice Address - Country:US
Practice Address - Phone:213-549-3222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-12
Last Update Date:2025-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA710101041C0700X, 1041C0700X
CAASW30539101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health