Provider Demographics
NPI:1861034514
Name:MONDESIR, VALERIE JUSTE
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:JUSTE
Last Name:MONDESIR
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 1:4600 SUMMERLIN RD
Mailing Address - Street 2:SUITE C-2 PMB 265
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-1063
Mailing Address - Country:US
Mailing Address - Phone:203-898-2197
Mailing Address - Fax:
Practice Address - Street 1:22 LONG RIDGE RD
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-3812
Practice Address - Country:US
Practice Address - Phone:203-323-8560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-15
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT3771106H00000X
CT002112106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty