Provider Demographics
NPI:1992965966
Name:VALENTE, JERRY R (PHD, JD)
Entity type:Individual
Prefix:
First Name:JERRY
Middle Name:R
Last Name:VALENTE
Suffix:
Gender:M
Credentials:PHD, JD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3733 UNIVERSITY BLVD W
Mailing Address - Street 2:SUITE 208
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32217-2109
Mailing Address - Country:US
Mailing Address - Phone:904-733-1865
Mailing Address - Fax:904-733-1864
Practice Address - Street 1:3733 UNIVERSITY BLVD W
Practice Address - Street 2:SUITE 208
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32217-2109
Practice Address - Country:US
Practice Address - Phone:904-733-1865
Practice Address - Fax:904-733-1864
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-13
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY6919103T00000X
GA887103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist