Provider Demographics
NPI:1124410436
Name:VALDEMIRA, DANA (PHD, LMHC)
Entity type:Individual
Prefix:DR
First Name:DANA
Middle Name:
Last Name:VALDEMIRA
Suffix:
Gender:F
Credentials:PHD, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 CLEREMONT AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT JAMES
Mailing Address - State:NY
Mailing Address - Zip Code:11780-1708
Mailing Address - Country:US
Mailing Address - Phone:516-380-3453
Mailing Address - Fax:
Practice Address - Street 1:267 E MAIN ST STE B22
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-2851
Practice Address - Country:US
Practice Address - Phone:516-380-3453
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-23
Last Update Date:2020-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006695101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health