Healthcare Provider Details

I. General information

NPI: 1235093048
Provider Name (Legal Business Name): MONICA TERESA WILDA VALVILLE-QUINTERO LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1037 HARRISON DR
CENTERPORT NY
11721-1060
US

IV. Provider business mailing address

1037 HARRISON DR
CENTERPORT NY
11721-1060
US

V. Phone/Fax

Practice location:
  • Phone: 631-513-5617
  • Fax:
Mailing address:
  • Phone: 631-513-5617
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number013272
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: