Provider Demographics
NPI:1679702468
Name:VALENTINE, MILLICENT DAELEIGH (PSYD)
Entity type:Individual
Prefix:
First Name:MILLICENT
Middle Name:DAELEIGH
Last Name:VALENTINE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 N MARENGO AVE
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-1764
Mailing Address - Country:US
Mailing Address - Phone:626-585-8075
Mailing Address - Fax:
Practice Address - Street 1:95 N MARENGO AVE
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-1764
Practice Address - Country:US
Practice Address - Phone:626-585-8075
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-14
Last Update Date:2014-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY25393103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical