Healthcare Provider Details

I. General information

NPI: 1902333172
Provider Name (Legal Business Name): JOSE ALBERTO VALENTIN PHD, LPC, LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: JOSE A. VALENTIN, PHD CLINICAL PSYCHOLOGY

II. Dates (important events)

Enumeration Date: 05/17/2017
Last Update Date: 05/15/2025
Certification Date: 05/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 SOMERS RD UNIT 2A
ELLINGTON CT
06029-2629
US

IV. Provider business mailing address

PO BOX 83
ELLINGTON CT
06029-0083
US

V. Phone/Fax

Practice location:
  • Phone: 203-648-1054
  • Fax:
Mailing address:
  • Phone: 203-648-1054
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLMHC10004283
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberTAC-III-05-20-4196
License Number StatePR
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number5162
License Number StateCT
# 4
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLMHC10004283
License Number StateMA
# 5
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License NumberTCC-I-05-20-4196
License Number StatePR
# 6
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number5162
License Number StateCT
# 7
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLMHC10004283
License Number StateMA
# 8
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number5162
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: