Provider Demographics
NPI:1578139440
Name:VALENTIN, EMMANUELLA I (MISS)
Entity Type:Individual
Prefix:MS
First Name:EMMANUELLA
Middle Name:
Last Name:VALENTIN
Suffix:I
Gender:F
Credentials:MISS
Other - Prefix:MS
Other - First Name:EMMANUELLA
Other - Middle Name:
Other - Last Name:VALENTIN
Other - Suffix:I
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:149 HALSTED ST APT 103
Mailing Address - Street 2:
Mailing Address - City:EAST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07018-2643
Mailing Address - Country:US
Mailing Address - Phone:609-598-0791
Mailing Address - Fax:
Practice Address - Street 1:123 N UNION AVE STE 204
Practice Address - Street 2:
Practice Address - City:CRANFORD
Practice Address - State:NJ
Practice Address - Zip Code:07016-2198
Practice Address - Country:US
Practice Address - Phone:732-925-6972
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-01
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician