Provider Demographics
NPI:1386740835
Name:DELLA VALLE, JOANNE M (LCSW)
Entity type:Individual
Prefix:
First Name:JOANNE
Middle Name:M
Last Name:DELLA VALLE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JOANNE
Other - Middle Name:M
Other - Last Name:GORMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:PO BOX 31092
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06150-1092
Mailing Address - Country:US
Mailing Address - Phone:518-952-8140
Mailing Address - Fax:518-952-8287
Practice Address - Street 1:55 ELM ST
Practice Address - Street 2:
Practice Address - City:GLENS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12801-3549
Practice Address - Country:US
Practice Address - Phone:518-793-7273
Practice Address - Fax:518-798-5004
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0523501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01420800Medicaid
NYRA7562Medicare ID - Type Unspecified