Provider Demographics
NPI:1700091022
Name:VALENTIN, WANDA (BS, CADC, CCS)
Entity Type:Individual
Prefix:
First Name:WANDA
Middle Name:
Last Name:VALENTIN
Suffix:
Gender:F
Credentials:BS, CADC, CCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 BREWSTER LN
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:CT
Mailing Address - Zip Code:06484-3319
Mailing Address - Country:US
Mailing Address - Phone:203-394-6529
Mailing Address - Fax:203-384-8835
Practice Address - Street 1:180 FAIRFIELD AVE
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06604-4252
Practice Address - Country:US
Practice Address - Phone:203-394-6529
Practice Address - Fax:203-384-8835
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTCAC1213101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)