Provider Demographics
NPI:1194600239
Name:VALDEZ, ANTONIO (PPS, LCSW)
Entity type:Individual
Prefix:
First Name:ANTONIO
Middle Name:
Last Name:VALDEZ
Suffix:
Gender:X
Credentials:PPS, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 VAN NESS AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93721-2002
Mailing Address - Country:US
Mailing Address - Phone:559-265-3000
Mailing Address - Fax:
Practice Address - Street 1:1905 7TH ST
Practice Address - Street 2:
Practice Address - City:SANGER
Practice Address - State:CA
Practice Address - Zip Code:93657-2897
Practice Address - Country:US
Practice Address - Phone:559-524-6521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-07
Last Update Date:2025-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X, 1041S0200X, 101YS0200X
CA1296451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool