Provider Demographics
NPI:1982972519
Name:VALDEZ, ANTONIO MANUEL (CASAC)
Entity type:Individual
Prefix:MR
First Name:ANTONIO
Middle Name:MANUEL
Last Name:VALDEZ
Suffix:
Gender:M
Credentials:CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:72 SEAMAN AVE
Mailing Address - Street 2:APARTMENT 4-H
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10034-2822
Mailing Address - Country:US
Mailing Address - Phone:646-964-5396
Mailing Address - Fax:646-964-5396
Practice Address - Street 1:72 SEAMAN AVE
Practice Address - Street 2:APARTMENT 4-H
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10034-2822
Practice Address - Country:US
Practice Address - Phone:646-964-5396
Practice Address - Fax:646-964-5396
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-10
Last Update Date:2011-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY19543324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility