Provider Demographics
NPI:1992316400
Name:VALLER GORFIEN, EMILEE CARMEN (PHD)
Entity type:Individual
Prefix:DR
First Name:EMILEE
Middle Name:CARMEN
Last Name:VALLER GORFIEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:EMILEE
Other - Middle Name:CARMEN
Other - Last Name:VALLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:15 CORNELL RD STE 2
Mailing Address - Street 2:
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-1490
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15 CORNELL RD STE 2
Practice Address - Street 2:
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-1490
Practice Address - Country:US
Practice Address - Phone:518-510-3100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-10
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHP.08089103TC2200X
NY024833103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent