Basic Information
Provider Information
NPI: 1558379321
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: VALENTI
FirstName: ELIZABETH
MiddleName: H
NamePrefix:  
NameSuffix:  
Credential: COUNSELOR
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 936
Address2:  
City: NORFOLK
State: VA
PostalCode: 235010936
CountryCode: US
TelephoneNumber: 7574460374
FaxNumber: 7576242272
Practice Location
Address1: 825 FAIRFAX AVE
Address2:  
City: NORFOLK
State: VA
PostalCode: 235071914
CountryCode: US
TelephoneNumber: 7574465897
FaxNumber: 7576242272
Other Information
ProviderEnumerationDate: 08/04/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
170300000X93060VAY Other Service ProvidersGenetic Counselor, MS 

No ID Information.


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