Healthcare Provider Details

I. General information

NPI: 1992184642
Provider Name (Legal Business Name): DELIA VANESSA VALENZUELA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2015
Last Update Date: 05/14/2021
Certification Date: 05/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 E TAHQUITZ CANYON WAY
PALM SPRINGS CA
92262-6982
US

IV. Provider business mailing address

45805 FARGO ST # 2336
INDIO CA
92201-4584
US

V. Phone/Fax

Practice location:
  • Phone: 760-771-7327
  • Fax:
Mailing address:
  • Phone: 760-771-7327
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number97833
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberASW73380
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: