Provider Demographics
NPI:1801556824
Name:VALENTINE, LEEANNE
Entity type:Individual
Prefix:
First Name:LEEANNE
Middle Name:
Last Name:VALENTINE
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 1:23 HAVENWOOD HOLW
Mailing Address - Street 2:
Mailing Address - City:FAIRPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14450-8718
Mailing Address - Country:US
Mailing Address - Phone:585-286-1940
Mailing Address - Fax:
Practice Address - Street 1:23 HAVENWOOD HOLW
Practice Address - Street 2:
Practice Address - City:FAIRPORT
Practice Address - State:NY
Practice Address - Zip Code:14450-8718
Practice Address - Country:US
Practice Address - Phone:585-286-1940
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-20
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist