Healthcare Provider Details

I. General information

NPI: 1588014534
Provider Name (Legal Business Name): HEATHER VALDEZ LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2016
Last Update Date: 02/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2185 ASHBY AVE
BERKELEY CA
94705
US

IV. Provider business mailing address

5111 TELEGRAPH AVE #172
OAKLAND CA
94609-1925
US

V. Phone/Fax

Practice location:
  • Phone: 510-686-3203
  • Fax:
Mailing address:
  • Phone: 916-730-3571
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number86545
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: