MEDICARE: DR. ROBERT JAMES VALENTI PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	010630	NY
2	103TC2200X	Clinical Child & Adolescent Psychologist	010630	NY
3	103TB0200X	Cognitive & Behavioral Psychologist	010630	NY
4	103TM1800X	Intellectual & Developmental Disabilities Psychologist	010630	NY
5	103TS0200X	School Psychologist	010630	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	535545	OTHER		VALUE OPTIONS
3	100315	OTHER	NY	PREFERRED CARE
4	11334640	OTHER		CAQH (AETNA)

General Provider Information

NPI Number	:	1255447751
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT JAMES VALENTI PH.D.

Provider Business Mailing Address
First Line	:	38 KIRKBY TRAIL
Second Line	:
City	:	FAIRPORT
State	:	NY
Zip	:	14450
Country	:	US
Telephone Number	:	585-797-5599
Fax Number	:

Provider Business Practice Location Address
First Line	:	490 CROSS KEYS OFFICE PARK
Second Line	:
City	:	FAIRPORT
State	:	NY
Zip	:	14450-3506
Country	:	US
Telephone Number	:	585-797-5599
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/21/2006
Last Update Date	:	07/14/2007

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