Healthcare Provider Details

I. General information

NPI: 1518774942
Provider Name (Legal Business Name): CHRISSIE NIZA VALENTIN APRN, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2024
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
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: 413-205-4219
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number16971
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: