Provider Demographics
NPI:1902333172
Name:VALENTIN, JOSE ALBERTO (PHD, LPC, LMHC)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:ALBERTO
Last Name:VALENTIN
Suffix:
Gender:M
Credentials:PHD, LPC, LMHC
Other - Prefix:DR
Other - First Name:JOSE
Other - Middle Name:A
Other - Last Name:VALENTIN, PHD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CLINICAL PSYCHOLOGY
Mailing Address - Street 1:PO BOX 83
Mailing Address - Street 2:
Mailing Address - City:ELLINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06029-0083
Mailing Address - Country:US
Mailing Address - Phone:203-648-1054
Mailing Address - Fax:
Practice Address - Street 1:420 SOMERS RD UNIT 2A
Practice Address - Street 2:
Practice Address - City:ELLINGTON
Practice Address - State:CT
Practice Address - Zip Code:06029-2629
Practice Address - Country:US
Practice Address - Phone:203-648-1054
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-17
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT5162101Y00000X, 101YM0800X, 101YP2500X, 101YP2500X, 101YP2500X
PRTAC-III-05-20-4196101YA0400X
PRTCC-I-05-20-4196101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral