Provider Demographics
NPI:1720117237
Name:VALENZUELA, TEDDIE DARLENE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:TEDDIE
Middle Name:DARLENE
Last Name:VALENZUELA
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 1:14 MOUNTAIN LAUREL WAY
Mailing Address - Street 2:
Mailing Address - City:AZUSA
Mailing Address - State:CA
Mailing Address - Zip Code:91702-6264
Mailing Address - Country:US
Mailing Address - Phone:626-969-1520
Mailing Address - Fax:
Practice Address - Street 1:1200 WILSHIRE BLVD STE 100
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017-1932
Practice Address - Country:US
Practice Address - Phone:213-482-9400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS223061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical