Healthcare Provider Details

I. General information

NPI: 1114646718
Provider Name (Legal Business Name): STEPHANIE NICOLE VALVERDE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2022
Last Update Date: 02/14/2025
Certification Date: 02/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27TH SPECIAL OPERATIONS MEDICAL GROUP 224 W.D.LINGRAM AVE. BLDG 1408
CANNON AFB NM
88103
US

IV. Provider business mailing address

6708 91ST ST
LUBBOCK TX
79424-6735
US

V. Phone/Fax

Practice location:
  • Phone: 575-784-4228
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number66891
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: