Provider Demographics
NPI:1174008742
Name:PENALBA, VALENTINA
Entity Type:Individual
Prefix:DR
First Name:VALENTINA
Middle Name:
Last Name:PENALBA
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 1:10612 BALLANTRAE DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63131-2830
Mailing Address - Country:US
Mailing Address - Phone:314-606-1129
Mailing Address - Fax:
Practice Address - Street 1:7750 CLAYTON RD STE 204
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63117-1342
Practice Address - Country:US
Practice Address - Phone:314-606-1129
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-30
Last Update Date:2018-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015010341106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist