Provider Demographics
NPI:1235405101
Name:VALENTINE, WILFRED (MA)
Entity Type:Individual
Prefix:MR
First Name:WILFRED
Middle Name:
Last Name:VALENTINE
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB. SIERRA REAL CALLE1
Mailing Address - Street 2:#260
Mailing Address - City:CAYEY
Mailing Address - State:PR
Mailing Address - Zip Code:00736-9003
Mailing Address - Country:US
Mailing Address - Phone:939-630-5517
Mailing Address - Fax:
Practice Address - Street 1:MARGINAL TURQUESA URB. BUCARE 2100
Practice Address - Street 2:105
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969
Practice Address - Country:US
Practice Address - Phone:939-630-5517
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-26
Last Update Date:2012-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4222103T00000X, 103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling