MEDICARE: ODALYS A VALENCIA LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	SW 6436	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	SW 6436	OTHER	FL	LCSW

General Provider Information

NPI Number	:	1306989454
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ODALYS A VALENCIA LCSW

Provider Business Mailing Address
First Line	:	5979 NW 151ST ST
Second Line	:	SUITE # 230
City	:	HIALEAH
State	:	FL
Zip	:	33014-2400
Country	:	US
Telephone Number	:	305-362-1875
Fax Number	:	305-362-1920

Provider Business Practice Location Address
First Line	:	5979 NW 151ST ST
Second Line	:	SUITE # 230
City	:	HIALEAH
State	:	FL
Zip	:	33014-2400
Country	:	US
Telephone Number	:	305-362-1875
Fax Number	:	305-362-1920

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/15/2007
Last Update Date	:	11/16/2012

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