Provider Demographics
NPI:1063988665
Name:RODAS-VALDEZ, NELLY
Entity type:Individual
Prefix:MRS
First Name:NELLY
Middle Name:
Last Name:RODAS-VALDEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:744 MANIDA ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10474-5808
Mailing Address - Country:US
Mailing Address - Phone:718-877-0105
Mailing Address - Fax:
Practice Address - Street 1:1432 5TH AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10035-4521
Practice Address - Country:US
Practice Address - Phone:646-289-7716
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-22
Last Update Date:2018-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker