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General NPI Number Information
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NPI Number | 1417551110
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Entity Type | Organization
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Legal Business Name | DR. VALENTINA, LLC
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Dates
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Enumeration Date | 11/24/2020
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Last Update Date | 05/20/2024
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Provider Practice Location Address
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Address Line | 11848 S WESTERN AVE
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City | CHICAGO
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State | IL
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Zip | 60643-4734
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Country | US
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Telephone | 773-431-0486
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Fax |
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Provider Business Mailing Address
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Address Line | 6011 S MENARD AVE
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City | CHICAGO
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State | IL
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Zip | 60638-4419
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Country | US
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Telephone | 773-431-0486
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Fax |
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST/OWNER
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Name | DR. VALENTINA MARIE PACHECO-CORNEJO
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Credential | PSY.D
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Telephone | 773-431-0486
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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