Provider Demographics
NPI:1306948351
Name:VALENTINO, KATHLEEN M (LCPC)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:M
Last Name:VALENTINO
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6224
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60108-6224
Mailing Address - Country:US
Mailing Address - Phone:630-946-9500
Mailing Address - Fax:630-513-5657
Practice Address - Street 1:127 E LAKE ST
Practice Address - Street 2:SUITE 203B
Practice Address - City:BLOOMINGDALE
Practice Address - State:IL
Practice Address - Zip Code:60108-1180
Practice Address - Country:US
Practice Address - Phone:630-946-9500
Practice Address - Fax:630-513-5657
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL210119Medicare ID - Type UnspecifiedGROUP ID NUMBER
IL210118Medicare ID - Type UnspecifiedGROUP ID NUMBER