Provider Demographics
NPI:1053557926
Name:VALDEZ, ANGELITA E (LMSW)
Entity type:Individual
Prefix:MRS
First Name:ANGELITA
Middle Name:E
Last Name:VALDEZ
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1588
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49443-1588
Mailing Address - Country:US
Mailing Address - Phone:231-343-1360
Mailing Address - Fax:
Practice Address - Street 1:1061 S GETTY ST
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49442-4066
Practice Address - Country:US
Practice Address - Phone:231-722-7980
Practice Address - Fax:231-722-7979
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-26
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X, 1041S0200X
MI6801088033104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1712452Medicaid
750910519Medicare UPIN
MIOP22320Medicare PIN
750910513Medicare UPIN
750910530Medicare UPIN
MI1712452Medicaid
750910532Medicare UPIN
MI20378Medicare UPIN
750910524Medicare UPIN
750910527Medicare UPIN
20366Medicare UPIN
750910517Medicare UPIN
20351Medicare UPIN