Provider Demographics
NPI:1205344090
Name:CHONTOFALSKY, VALERIE (LICSW)
Entity type:Individual
Prefix:
First Name:VALERIE
Middle Name:
Last Name:CHONTOFALSKY
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5299
Mailing Address - Street 2:1220-2-PSY
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98415
Mailing Address - Country:US
Mailing Address - Phone:253-403-4305
Mailing Address - Fax:253-403-1235
Practice Address - Street 1:315 MARTIN LUTHER KING JR WAY
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-4234
Practice Address - Country:US
Practice Address - Phone:253-403-4305
Practice Address - Fax:253-403-1235
Is Sole Proprietor?:No
Enumeration Date:2018-01-16
Last Update Date:2018-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW606292571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical