Provider Demographics
NPI:1366807125
Name:VALZ, LUAN
Entity type:Individual
Prefix:
First Name:LUAN
Middle Name:
Last Name:VALZ
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 1:38 ROUND LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NY
Mailing Address - Zip Code:10950-1416
Mailing Address - Country:US
Mailing Address - Phone:845-806-6155
Mailing Address - Fax:
Practice Address - Street 1:38 ROUND LAKE AVE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NY
Practice Address - Zip Code:10950-1416
Practice Address - Country:US
Practice Address - Phone:845-806-6155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-22
Last Update Date:2015-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY28868OtherCASAC