Healthcare Provider Details

I. General information

NPI: 1023015161
Provider Name (Legal Business Name): TERRI VALENCIA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2005
Last Update Date: 10/29/2024
Certification Date: 10/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1043 BROOKLYN BLVD
BEREA KY
40403-1090
US

IV. Provider business mailing address

8206 HIGHVIEW CT
CRESTWOOD KY
40014-8105
US

V. Phone/Fax

Practice location:
  • Phone: 502-262-2887
  • Fax:
Mailing address:
  • Phone: 859-582-2666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1161
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: