Healthcare Provider Details

I. General information

NPI: 1710582846
Provider Name (Legal Business Name): JENNIFER DEL VALLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER GILL

II. Dates (important events)

Enumeration Date: 12/04/2020
Last Update Date: 12/04/2020
Certification Date: 12/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 NORTH RD
POUGHKEEPSIE NY
12601-1328
US

IV. Provider business mailing address

29 N HAMILTON ST # 314
POUGHKEEPSIE NY
12601-2541
US

V. Phone/Fax

Practice location:
  • Phone: 845-486-2703
  • Fax:
Mailing address:
  • Phone: 845-486-2703
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number107637-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: