Provider Demographics
NPI:1972617645
Name:VALLANTE, FAITH (LCSW)
Entity Type:Individual
Prefix:
First Name:FAITH
Middle Name:
Last Name:VALLANTE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2415 JERUSALEM AVE
Mailing Address - Street 2:107E
Mailing Address - City:NORTH BELLMORE
Mailing Address - State:NY
Mailing Address - Zip Code:11710-1870
Mailing Address - Country:US
Mailing Address - Phone:516-826-8001
Mailing Address - Fax:631-864-1688
Practice Address - Street 1:2415 JERUSALEM AVE
Practice Address - Street 2:107E
Practice Address - City:NORTH BELLMORE
Practice Address - State:NY
Practice Address - Zip Code:11710-1870
Practice Address - Country:US
Practice Address - Phone:516-826-8001
Practice Address - Fax:631-864-1688
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2013-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR017058-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN24661Medicare PIN