Provider Demographics
NPI:1003639626
Name:PRENCESVALLE, NOELIA ANA BELEN
Entity type:Individual
Prefix:
First Name:NOELIA
Middle Name:ANA BELEN
Last Name:PRENCESVALLE
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 1:389 PEARSON CIR
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-3051
Mailing Address - Country:US
Mailing Address - Phone:630-902-0081
Mailing Address - Fax:
Practice Address - Street 1:2603 S WASHINGTON ST STE 170
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60565-6377
Practice Address - Country:US
Practice Address - Phone:331-472-7132
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-02
Last Update Date:2024-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool