Provider Demographics
NPI:1720877723
Name:VALDES, MAXIMILIAN RAY
Entity type:Individual
Prefix:
First Name:MAXIMILIAN
Middle Name:RAY
Last Name:VALDES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14221 SW 120TH ST STE 126
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-7463
Mailing Address - Country:US
Mailing Address - Phone:786-577-3427
Mailing Address - Fax:305-402-3728
Practice Address - Street 1:14221 SW 120TH ST STE 126
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-7463
Practice Address - Country:US
Practice Address - Phone:786-577-3427
Practice Address - Fax:305-402-3728
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-05
Last Update Date:2025-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty