Healthcare Provider Details

I. General information

NPI: 1801216528
Provider Name (Legal Business Name): BIENVENIDO JOHN VALENTIN JR. PSYD, PH.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2014
Last Update Date: 04/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1975 S JOHN YOUNG PKWY SUITE 101 A
KISSIMMEE FL
34741-0603
US

IV. Provider business mailing address

1975 S JOHN YOUNG PKWY SUITE 101 A
KISSIMMEE FL
34741-0603
US

V. Phone/Fax

Practice location:
  • Phone: 407-715-6062
  • Fax:
Mailing address:
  • Phone: 407-715-6062
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number7660
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: