Doctor Name: | JACK VALLEJO |
NPI Number: | 1346626181 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MSW, LCSWC |
License Number: | 07259 |
Business Practice Address: | 1311 Londontown Blvd Suite # 130a Eldersburg, MD - 217846454 |
Business Phone Number: | 4103569200 |
Business Fax Number: | 4432000267 |
Mailing Address: | Po Box 1229, SYKESVILLE |
State: | MD |
Postal Code: | 217841229 |
Phone Number: | 4103569200 |
Fax Number: | 4432000267 |
NPI Enumeration Date: | 08/04/2015 |
NPI Last Update Date: | 08/04/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041S0200X |
License Number: | 07259 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MD |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | School |
Taxonomy Definition: |