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General NPI Number Information
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NPI Number | 1891094918
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Entity Type | Individual
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Provider Name | SELENE A VALDEZ LCSW
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Gender | Female
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Dates
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Enumeration Date | 03/16/2011
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Last Update Date | 03/16/2011
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Provider Practice Location Address
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Address Line | 4112 OUTLOOK BLVD
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City | PUEBLO
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State | CO
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Zip | 81008-1667
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Country | US
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Telephone | 719-553-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 114 US HWY 50 PO BOX 153
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City | AVONDALE
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State | CO
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Zip | 81022
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Country | US
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Telephone | 719-566-0345
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 1089
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License Number State | CO
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