Provider Demographics
NPI:1669737102
Name:ORTEGA-VALENTIN, ANGEL GADIEL (LCSW)
Entity type:Individual
Prefix:MR
First Name:ANGEL
Middle Name:GADIEL
Last Name:ORTEGA-VALENTIN
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 1:13110 ELK MOUNTAIN DR
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33579-7182
Mailing Address - Country:US
Mailing Address - Phone:813-349-7567
Mailing Address - Fax:813-671-1696
Practice Address - Street 1:801 E BAKER ST
Practice Address - Street 2:
Practice Address - City:PLANT CITY
Practice Address - State:FL
Practice Address - Zip Code:33563-3652
Practice Address - Country:US
Practice Address - Phone:813-653-6100
Practice Address - Fax:813-938-6423
Is Sole Proprietor?:No
Enumeration Date:2012-07-11
Last Update Date:2021-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
FLSW169231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker