Provider Demographics
NPI:1265155972
Name:VALENTINE, LEONARDO ADRIAN
Entity type:Individual
Prefix:
First Name:LEONARDO
Middle Name:ADRIAN
Last Name:VALENTINE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1024 IRON POINT RD STE 100-1495
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-8013
Mailing Address - Country:US
Mailing Address - Phone:916-276-9675
Mailing Address - Fax:
Practice Address - Street 1:1024 IRON POINT RD STE 100-1495
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-8013
Practice Address - Country:US
Practice Address - Phone:916-276-9675
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-19
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAMFT132876106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty