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NPI Code Detail

MEDICARE: ALEJANDRO VALDIVIESO

MEDICARE:   ALEJANDRO  VALDIVIESO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health CounselorNY

General Provider Information

NPI Number : 1780312900
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALEJANDRO VALDIVIESO
Provider Business Mailing Address
First Line : 420 CENTRAL PARK W APT 1C
Second Line :
City : NEW YORK
State : NY
Zip : 10025-4311
Country : US
Telephone Number : 312-497-8957
Fax Number :
Provider Business Practice Location Address
First Line : 28 W 25TH ST FL 10
Second Line :
City : NEW YORK
State : NY
Zip : 10010-2736
Country : US
Telephone Number : 646-767-6330
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/15/2022
Last Update Date : 08/15/2022

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Directions to “ ALEJANDRO VALDIVIESO ” Practice Location

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