Healthcare Provider Details

I. General information

NPI: 1568084713
Provider Name (Legal Business Name): DANITZA JEANETTE VALLE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2020
Last Update Date: 05/11/2020
Certification Date: 05/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3690 S PARK AVE STE 805
TUCSON AZ
85713-5042
US

IV. Provider business mailing address

4066 E ROBERTS PL
TUCSON AZ
85711-1036
US

V. Phone/Fax

Practice location:
  • Phone: 520-616-6760
  • Fax:
Mailing address:
  • Phone: 520-270-2911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-18529
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: