MEDICARE: EDWARD MIGUEL VALENTIN 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	CSW004884	GA

General Provider Information

NPI Number	:	1821432444
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDWARD MIGUEL VALENTIN LCSW

Provider Business Mailing Address
First Line	:	196 BANYON CT
Second Line	:
City	:	DALLAS
State	:	GA
Zip	:	30157-5104
Country	:	US
Telephone Number	:	678-744-8336
Fax Number	:

Provider Business Practice Location Address
First Line	:	126 ENTERPRISE PATH STE 104B
Second Line	:
City	:	HIRAM
State	:	GA
Zip	:	30141-2655
Country	:	US
Telephone Number	:	770-256-7078
Fax Number	:

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

Provider Enumeration Date	:	04/25/2013
Last Update Date	:	11/04/2019

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