MEDICARE: DR. VALENTINA, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101YP2500X	Professional Counselor
2	104100000X	Social Worker
3	1041C0700X	Clinical Social Worker
4	103TC0700X	Clinical Psychologist

General Provider Information

NPI Number	:	1417551110
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR. VALENTINA, LLC

Provider Business Mailing Address
First Line	:	6011 S MENARD AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60638-4419
Country	:	US
Telephone Number	:	773-431-0486
Fax Number	:

Provider Business Practice Location Address
First Line	:	11848 S WESTERN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60643-4734
Country	:	US
Telephone Number	:	773-431-0486
Fax Number	:

Authorized Official
Title or Position	:	CLINICAL PSYCHOLOGIST/OWNER
Name	:	DR. VALENTINA MARIE PACHECO-CORNEJO
Credential	:	PSY.D
Telephone Number	:	773-431-0486

Provider Enumeration Date	:	11/24/2020
Last Update Date	:	05/20/2024

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