Healthcare Provider Details

I. General information

NPI: 1992316400
Provider Name (Legal Business Name): EMILEE CARMEN VALLER GORFIEN PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EMILEE CARMEN VALLER PHD

II. Dates (important events)

Enumeration Date: 08/10/2020
Last Update Date: 01/27/2023
Certification Date: 01/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 CORNELL RD STE 2
LATHAM NY
12110-1490
US

IV. Provider business mailing address

15 CORNELL RD STE 2
LATHAM NY
12110-1490
US

V. Phone/Fax

Practice location:
  • Phone: 518-510-3100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberP.08089
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number024833
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: