Provider Demographics
NPI:1336208776
Name:VALLA, DANIEL MATTHEW (LCSW)
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:MATTHEW
Last Name:VALLA
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 PATCH RD
Mailing Address - Street 2:
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13901-5625
Mailing Address - Country:US
Mailing Address - Phone:607-648-8730
Mailing Address - Fax:
Practice Address - Street 1:3 OHARA DR
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:NY
Practice Address - Zip Code:13815-2046
Practice Address - Country:US
Practice Address - Phone:607-334-8244
Practice Address - Fax:607-336-5779
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY60687104100000X
NY076246-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker