Provider Demographics
NPI:1114561412
Name:SARA VALENTINO PHD LLC
Entity type:Organization
Organization Name:SARA VALENTINO PHD LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:SARA
Authorized Official - Middle Name:
Authorized Official - Last Name:VALENTINO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LP
Authorized Official - Phone:540-553-5574
Mailing Address - Street 1:500 W FRANKLIN AVE APT 105
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55405-3654
Mailing Address - Country:US
Mailing Address - Phone:540-553-5574
Mailing Address - Fax:
Practice Address - Street 1:970 RAYMOND AVE STE 105
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55114-1701
Practice Address - Country:US
Practice Address - Phone:612-440-1824
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-30
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1114561412Medicaid