=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295529105
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JODI LYNNE VALENTINE-SANSON LCSWR
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/07/2025
-----------------------------------------------------
Last Update Date | 04/07/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5008 BRITTONFIELD PKWY
-----------------------------------------------------
City | EAST SYRACUSE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13057-9248
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-472-7504
-----------------------------------------------------
Fax | 315-479-8639
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7587 BRIDGEPORT KIRKVILLE RD
-----------------------------------------------------
City | KIRKVILLE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13082-9201
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-263-6926
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | R052865
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------