Provider Demographics
NPI:1972831212
Name:VALENTINE, SALLY MARIE (LCSW)
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:MARIE
Last Name:VALENTINE
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 1:1 W CAMINO REAL
Mailing Address - Street 2:SUITE 202
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33432-5966
Mailing Address - Country:US
Mailing Address - Phone:561-391-3305
Mailing Address - Fax:
Practice Address - Street 1:1 W CAMINO REAL
Practice Address - Street 2:SUITE 202
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33432-5966
Practice Address - Country:US
Practice Address - Phone:561-391-3305
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-24
Last Update Date:2009-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW62961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical