Provider Demographics
NPI:1487994323
Name:VALLEDOR, JANICE MARIE
Entity type:Individual
Prefix:
First Name:JANICE
Middle Name:MARIE
Last Name:VALLEDOR
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:CALLE 4,B-7, PARKSIDE
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00967
Mailing Address - Country:US
Mailing Address - Phone:787-200-0999
Mailing Address - Fax:
Practice Address - Street 1:CALLE 4,B-7, PARKSIDE
Practice Address - Street 2:
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00967
Practice Address - Country:US
Practice Address - Phone:787-200-0999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-28
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2824103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool