Provider Demographics
NPI:1508917402
Name:VALLELUNGA, LORI R (PHD)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:R
Last Name:VALLELUNGA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 ACADEMY WAY S APT 221
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33711-5130
Mailing Address - Country:US
Mailing Address - Phone:708-261-6086
Mailing Address - Fax:
Practice Address - Street 1:6 ACADEMY WAY S APT 221
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33711-5130
Practice Address - Country:US
Practice Address - Phone:708-261-6086
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY-9797103TC0700X, 103TC0700X
IL071-005147103TB0200X, 103TC0700X, 103TC2200X, 103TH0100X, 103TM1800X, 103TR0400X
IL071005147103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
No103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation