Provider Demographics
NPI:1801562210
Name:RECALDE, VICTOR JOSE (BS, MS)
Entity type:Individual
Prefix:
First Name:VICTOR
Middle Name:JOSE
Last Name:RECALDE
Suffix:
Gender:M
Credentials:BS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5345 NOBEL DR UNIT 7
Mailing Address - Street 2:
Mailing Address - City:FITCHBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53711-4975
Mailing Address - Country:US
Mailing Address - Phone:505-417-6318
Mailing Address - Fax:
Practice Address - Street 1:5345 NOBEL DR UNIT 7
Practice Address - Street 2:
Practice Address - City:FITCHBURG
Practice Address - State:WI
Practice Address - Zip Code:53711-4975
Practice Address - Country:US
Practice Address - Phone:505-417-6318
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-17
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist