Provider Demographics
NPI:1629613781
Name:VALLARIO, JESSICA (LMHC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:VALLARIO
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:465 WOLF HILL RD
Mailing Address - Street 2:
Mailing Address - City:DIX HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11746-5722
Mailing Address - Country:US
Mailing Address - Phone:631-466-7163
Mailing Address - Fax:
Practice Address - Street 1:465 WOLF HILL RD
Practice Address - Street 2:
Practice Address - City:DIX HILLS
Practice Address - State:NY
Practice Address - Zip Code:11746-5722
Practice Address - Country:US
Practice Address - Phone:631-466-7163
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-13
Last Update Date:2019-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009709101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health