Provider Demographics
NPI:1417055666
Name:VALLELONGA, DAMIAN SALVATORE (PHD)
Entity Type:Individual
Prefix:DR
First Name:DAMIAN
Middle Name:SALVATORE
Last Name:VALLELONGA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 SHERBOURNE RD.
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13224-1929
Mailing Address - Country:US
Mailing Address - Phone:315-446-3114
Mailing Address - Fax:315-446-0053
Practice Address - Street 1:315 S CROUSE AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-1845
Practice Address - Country:US
Practice Address - Phone:315-426-2805
Practice Address - Fax:315-446-0053
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009258103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist