Provider Demographics
NPI:1417551110
Name:DR. VALENTINA, LLC
Entity Type:Organization
Organization Name:DR. VALENTINA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VALENTINA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:PACHECO-CORNEJO
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:773-431-0486
Mailing Address - Street 1:6011 S MENARD AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60638-4419
Mailing Address - Country:US
Mailing Address - Phone:773-431-0486
Mailing Address - Fax:
Practice Address - Street 1:11848 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60643-4734
Practice Address - Country:US
Practice Address - Phone:773-431-0486
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-24
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty