Provider Demographics
NPI:1013062199
Name:VALENTINO, NICOLE VANESSA
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:VANESSA
Last Name:VALENTINO
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 1:960 YUBA ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:CA
Mailing Address - Zip Code:94805-1127
Mailing Address - Country:US
Mailing Address - Phone:510-374-3261
Mailing Address - Fax:
Practice Address - Street 1:303 41ST ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94805-2221
Practice Address - Country:US
Practice Address - Phone:510-374-7392
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health