MEDICARE: VALENTINI THERAPY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0850X	Adult Mental Health Clinic/Center	071-006131	IL

General Provider Information

NPI Number	:	1568969780
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VALENTINI THERAPY LLC

Provider Business Mailing Address
First Line	:	1020 E KENILWORTH AVE
Second Line	:
City	:	LOMBARD
State	:	IL
Zip	:	60148-3146
Country	:	US
Telephone Number	:	630-632-5158
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 W ROOSEVELT RD
Second Line	:
City	:	WHEATON
State	:	IL
Zip	:	60187-2329
Country	:	US
Telephone Number	:	630-632-5158
Fax Number	:

Authorized Official
Title or Position	:	CLINICAL PSYCHOLOGIST
Name	:	DR. CONCORDIA VALENTINI
Credential	:	PSYD
Telephone Number	:	630-632-5158

Provider Enumeration Date	:	04/13/2018
Last Update Date	:	04/13/2018

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