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General NPI Number Information
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NPI Number | 1326550435
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Entity Type | Organization
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Legal Business Name | VALLEY OPTIMAL HEALTH, PC
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Dates
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Enumeration Date | 10/30/2017
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Last Update Date | 02/15/2024
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Provider Practice Location Address
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Address Line | 8 RIVER DR
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City | HADLEY
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State | MA
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Zip | 01035-3540
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Country | US
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Telephone | 413-582-1839
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Fax | 413-582-6855
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Provider Business Mailing Address
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Address Line | PO BOX 380
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City | HADLEY
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State | MA
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Zip | 01035-0380
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Country | US
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Telephone | 413-582-1839
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Fax | 413-582-6855
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Authorized Official
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Title or Position | OWNER
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Name | DR. BRUCE I GODEREZ
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Credential | MD
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Telephone | 413-582-1839
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 50762
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License Number State | MA
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