Provider Demographics
NPI:1720688732
Name:VALLIERE, ZIZO
Entity type:Individual
Prefix:
First Name:ZIZO
Middle Name:
Last Name:VALLIERE
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:ZIZO
Other - Middle Name:
Other - Last Name:HEALY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:17 DOUGLAS ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-6106
Mailing Address - Country:US
Mailing Address - Phone:774-274-7809
Mailing Address - Fax:
Practice Address - Street 1:17 DOUGLAS ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-6106
Practice Address - Country:US
Practice Address - Phone:774-274-7809
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-28
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician