Provider Demographics
NPI:1730826504
Name:MITVALSKY, LORETTA (LISW)
Entity type:Individual
Prefix:
First Name:LORETTA
Middle Name:
Last Name:MITVALSKY
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:LORETTA
Other - Middle Name:
Other - Last Name:LOPEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LISW
Mailing Address - Street 1:2000 BLAKE BLVD SE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52403-4420
Mailing Address - Country:US
Mailing Address - Phone:319-270-3298
Mailing Address - Fax:
Practice Address - Street 1:2000 BLAKE BLVD SE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52403-4420
Practice Address - Country:US
Practice Address - Phone:319-270-3298
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-13
Last Update Date:2022-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA052891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA05289OtherIOWA DEPARTMENT OF PUBLIC HEALTH (LISW)