Provider Demographics
NPI:1417229659
Name:VALLARELLI, AMY ANN (MS, LMHC, LCPC, NCC)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:ANN
Last Name:VALLARELLI
Suffix:
Gender:F
Credentials:MS, LMHC, LCPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 N LAKE SHORE DR APT 2015
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-6247
Mailing Address - Country:US
Mailing Address - Phone:914-606-2566
Mailing Address - Fax:
Practice Address - Street 1:1731 N MARCEY ST
Practice Address - Street 2:SUITE 535
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-5373
Practice Address - Country:US
Practice Address - Phone:914-606-2566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-03
Last Update Date:2014-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0050391101YM0800X
IL180008889101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health