Provider Demographics
NPI:1821456005
Name:VALENTIN, IRMA (TCM)
Entity Type:Individual
Prefix:
First Name:IRMA
Middle Name:
Last Name:VALENTIN
Suffix:
Gender:F
Credentials:TCM
Other - Prefix:
Other - First Name:IRMA
Other - Middle Name:
Other - Last Name:VALENTIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:IRMA VALENTIN
Mailing Address - Street 1:4166 KEY COLONY PL
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34746
Mailing Address - Country:US
Mailing Address - Phone:407-288-7648
Mailing Address - Fax:
Practice Address - Street 1:4166 KEY COLONY PL
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34746
Practice Address - Country:US
Practice Address - Phone:407-288-7648
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-03
Last Update Date:2016-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
FL171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health