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General NPI Number Information
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NPI Number | 1568969780
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Entity Type | Organization
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Legal Business Name | VALENTINI THERAPY LLC
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Dates
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Enumeration Date | 04/13/2018
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Last Update Date | 04/13/2018
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Provider Practice Location Address
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Address Line | 400 W ROOSEVELT RD
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City | WHEATON
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State | IL
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Zip | 60187-2329
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Country | US
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Telephone | 630-632-5158
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Fax |
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Provider Business Mailing Address
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Address Line | 1020 E KENILWORTH AVE
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City | LOMBARD
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State | IL
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Zip | 60148-3146
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Country | US
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Telephone | 630-632-5158
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Fax |
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST
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Name | DR. CONCORDIA VALENTINI
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Credential | PSYD
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Telephone | 630-632-5158
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 071-006131
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License Number State | IL
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