Healthcare Provider Details

I. General information

NPI: 1255672606
Provider Name (Legal Business Name): JENNIFER VALDIVIESO MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/11/2013
Last Update Date: 03/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 PILLING ST
BROOKLYN NY
11207-1610
US

IV. Provider business mailing address

10 STANTON ST APT. 5E
NEW YORK NY
10002-1215
US

V. Phone/Fax

Practice location:
  • Phone: 718-602-1000
  • Fax: 718-602-1111
Mailing address:
  • Phone: 646-852-2044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: