MEDICARE: VALDIVIESO PSYCH LLC

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	103TC0700X	Clinical Psychologist

General Provider Information

NPI Number	:	1699651869
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VALDIVIESO PSYCH LLC

Provider Business Mailing Address
First Line	:	1074 PONCE DE LEON AVE NE STE E
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30306-4216
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1074 PONCE DE LEON AVE NE STE E
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30306-4216
Country	:	US
Telephone Number	:	470-502-5130
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. VALERIA VALDIVIESO WRIGHT
Credential	:	PSY.D
Telephone Number	:	619-384-4629

Provider Enumeration Date	:	08/13/2025
Last Update Date	:	08/13/2025

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