Healthcare Provider Details

I. General information

NPI: 1205429537
Provider Name (Legal Business Name): RAFAEL VALENTIN LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/17/2021
Last Update Date: 02/17/2021
Certification Date: 02/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3708 91ST ST STE 3A
JACKSON HEIGHTS NY
11372-7962
US

IV. Provider business mailing address

2521 33RD ST FL 2
ASTORIA NY
11102-1235
US

V. Phone/Fax

Practice location:
  • Phone: 718-779-2263
  • Fax: 718-779-2225
Mailing address:
  • Phone: 203-685-3114
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: