MEDICARE: BRENDA VALENZUELA 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	108931	CA

General Provider Information

NPI Number	:	1841926060
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRENDA VALENZUELA LCSW

Provider Business Mailing Address
First Line	:	200 N GRAND AVE APT 254
Second Line	:
City	:	WEST COVINA
State	:	CA
Zip	:	91791-1748
Country	:	US
Telephone Number	:	323-491-8232
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 N GRAND AVE APT 254
Second Line	:
City	:	WEST COVINA
State	:	CA
Zip	:	91791-1748
Country	:	US
Telephone Number	:	323-491-8232
Fax Number	:

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

Provider Enumeration Date	:	07/29/2022
Last Update Date	:	07/29/2022

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