Provider Demographics
NPI:1801132188
Name:VALDEZ, MARINA G
Entity type:Individual
Prefix:MS
First Name:MARINA
Middle Name:G
Last Name:VALDEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 WALES ST APT 4
Mailing Address - Street 2:
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02124-1630
Mailing Address - Country:US
Mailing Address - Phone:617-602-5137
Mailing Address - Fax:
Practice Address - Street 1:12 WALES ST APT 4
Practice Address - Street 2:
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02124-1630
Practice Address - Country:US
Practice Address - Phone:617-602-5137
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-14
Last Update Date:2012-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor