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General NPI Number Information
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NPI Number | 1669841987
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Entity Type | Individual
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Provider Name | MICHAEL VALALIK PMHNP-BC
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Gender | Male
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Dates
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Enumeration Date | 09/16/2015
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Last Update Date | 03/01/2025
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Provider Practice Location Address
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Address Line | 770 SAYBROOK RD BLDG B
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City | MIDDLETOWN
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State | CT
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Zip | 06457-4739
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Country | US
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Telephone | 203-640-1563
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Fax | 203-774-1161
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Provider Business Mailing Address
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Address Line | PO BOX 2486
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City | MIDDLETOWN
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State | CT
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Zip | 06457-0034
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Country | US
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Telephone | 203-640-1563
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Fax | 203-774-1161
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 6276
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License Number State | CT
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