Healthcare Provider Details

I. General information

NPI: 1285578609
Provider Name (Legal Business Name): MARIAJOSE VALDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2026
Last Update Date: 04/16/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2440 RESERVOIR AVE
TRUMBULL CT
06611-4757
US

IV. Provider business mailing address

327 JOHNSON AVE
STRATFORD CT
06614-4745
US

V. Phone/Fax

Practice location:
  • Phone: 203-365-8522
  • Fax:
Mailing address:
  • Phone: 203-726-1110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number2328
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: