Provider Demographics
NPI:1962666362
Name:S. C. VALESSARES, PSY.D., INC.
Entity Type:Organization
Organization Name:S. C. VALESSARES, PSY.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:CHRISTINE
Authorized Official - Last Name:VALESSARES
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:630-881-7601
Mailing Address - Street 1:3 SQUIRE LN
Mailing Address - Street 2:
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60174-1413
Mailing Address - Country:US
Mailing Address - Phone:630-881-7601
Mailing Address - Fax:630-513-6839
Practice Address - Street 1:3 SQUIRE LN
Practice Address - Street 2:
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-1413
Practice Address - Country:US
Practice Address - Phone:630-881-7601
Practice Address - Fax:630-513-6839
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-15
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071-006810103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty