Provider Demographics
NPI:1114688157
Name:VALENTINE, BRIANA MALENA
Entity Type:Individual
Prefix:
First Name:BRIANA
Middle Name:MALENA
Last Name:VALENTINE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 STERLING LN
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17074-8832
Mailing Address - Country:US
Mailing Address - Phone:717-574-7741
Mailing Address - Fax:
Practice Address - Street 1:45 ROUTE 11
Practice Address - Street 2:
Practice Address - City:SHAMOKIN DAM
Practice Address - State:PA
Practice Address - Zip Code:17876-9116
Practice Address - Country:US
Practice Address - Phone:888-726-4776
Practice Address - Fax:570-362-5112
Is Sole Proprietor?:No
Enumeration Date:2022-01-03
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician