Provider Demographics
NPI:1467285262
Name:VALDEZ, OSVALDO
Entity type:Individual
Prefix:MR
First Name:OSVALDO
Middle Name:
Last Name:VALDEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2815 N MOODY AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60634-5016
Mailing Address - Country:US
Mailing Address - Phone:773-396-2097
Mailing Address - Fax:
Practice Address - Street 1:5210 MAIN ST
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-2158
Practice Address - Country:US
Practice Address - Phone:847-425-7500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-26
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health