Provider Demographics
NPI:1942654306
Name:VALENCIA, ELIZABETH G
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:G
Last Name:VALENCIA
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 1:4298 BANCROFT BLVD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32833-4704
Mailing Address - Country:US
Mailing Address - Phone:904-370-9540
Mailing Address - Fax:
Practice Address - Street 1:3201 E COLONIAL DR STE D46
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-5140
Practice Address - Country:US
Practice Address - Phone:407-730-7983
Practice Address - Fax:407-985-3678
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-21
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker