Provider Demographics
NPI:1457584716
Name:VALDEZ, MARLO M (BMS)
Entity type:Individual
Prefix:
First Name:MARLO
Middle Name:M
Last Name:VALDEZ
Suffix:
Gender:F
Credentials:BMS
Other - Prefix:
Other - First Name:MARLO
Other - Middle Name:M
Other - Last Name:GRIEGO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 28220
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87592-8220
Mailing Address - Country:US
Mailing Address - Phone:505-471-5006
Mailing Address - Fax:505-820-9220
Practice Address - Street 1:720 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NM
Practice Address - Zip Code:87701-4250
Practice Address - Country:US
Practice Address - Phone:505-454-8265
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-02
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMSWB-2024-1177104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker