Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TA0700X | Adult Development & Aging Psychologist | 35SI00434000 | NJ |
NPI | 1811093370 |
---|---|
Provider Name | Elvia Valencia |
First Address | Cliffside Park, NJ 07010-1018 |
Second Address | Cliffside Park, NJ 07010-1018 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2006 |
Last Update Date | 08/04/2021 |