Provider Demographics
NPI:1629261425
Name:VALENTINE, ERIN
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:VALENTINE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 CARRYING PLACE LN
Mailing Address - Street 2:
Mailing Address - City:SURRY
Mailing Address - State:ME
Mailing Address - Zip Code:04684-3605
Mailing Address - Country:US
Mailing Address - Phone:207-478-6558
Mailing Address - Fax:
Practice Address - Street 1:85 CARRYING PLACE LN
Practice Address - Street 2:
Practice Address - City:SURRY
Practice Address - State:ME
Practice Address - Zip Code:04684-3605
Practice Address - Country:US
Practice Address - Phone:207-478-6558
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-24
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2655103TC0700X
390200000X
MEPS2411103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program