Provider Demographics
NPI:1548631450
Name:VALENTINE, DANA CHRISTINE (BCABA)
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:CHRISTINE
Last Name:VALENTINE
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 RACQUET RD
Mailing Address - Street 2:
Mailing Address - City:WALL TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:07719-9406
Mailing Address - Country:US
Mailing Address - Phone:845-332-0826
Mailing Address - Fax:
Practice Address - Street 1:42 RACQUET RD
Practice Address - Street 2:
Practice Address - City:WALL TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:07719-9406
Practice Address - Country:US
Practice Address - Phone:845-332-0826
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-19
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ0-15-6628174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0-15-6628OtherBCABA