1386740835 NPI number — JOANNE M. DELLA VALLE LCSW

Table of content: JOANNE M. DELLA VALLE LCSW (NPI 1386740835)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386740835 NPI number — JOANNE M. DELLA VALLE LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DELLA VALLE
Provider First Name:
JOANNE
Provider Middle Name:
M.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GORMAN
Provider Other First Name:
JOANNE
Provider Other Middle Name:
M.
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1386740835
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 31092
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HARTFORD
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06150-1092
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-952-8140
Provider Business Mailing Address Fax Number:
518-952-8287

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
55 ELM ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GLENS FALLS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12801-3549
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-793-7273
Provider Business Practice Location Address Fax Number:
518-798-5004
Provider Enumeration Date:
09/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  052350 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 01420800 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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