Individual provider Active NPI

David Valentiner, PHD

  • Clinical Psychologist
  • Sycamore, IL
National Provider Identifier
1063866523
Registry record updated Apr 20, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
071005897 Issued in IL
Practice address
1625 Bethany Rd
Sycamore, IL 60178-3124
Phone
(815) 758-8400
NPI assigned
Apr 20, 2016
Last updated
Apr 20, 2016By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 20, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 071005897 IL Primary

Addresses

Primary practice location

1625 Bethany Rd
Sycamore, IL 60178-3124

Mailing address

1301 Ryan CT
Dekalb, IL 60115-5905
Phone (815) 787-6700

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160721000693 IL Practitioner - Clinical Psychologist 1557654076 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Professional Services in Health Psychology, LTDGroup PAC ID 4981736550, 19 clinicians

Practice addresses (Care Compare)

1625 Bethany Rd
Sycamore, IL 60178-3124
Phone (779) 777-7335

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
071005897ILMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Professional Services in Health Psychology, LTD Clinical CurrentSince Jul 1, 2016 Accepting new patients
Three Birds Mental Health Services PLLC Past Accepting new patients

Locations

1625 Bethany Rd
Sycamore, IL 60178
Phone (779) 777-7335

1625 Bethany Rd
Ste 1
Sycamore, IL 60178
Phone (779) 777-7335

2540 Hauser Ross Dr
Ste 225
Sycamore, IL 60178
Phone (815) 758-8400

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1461110400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1461110400000",
    "number": "1063866523",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1301 RYAN CT",
            "city": "DEKALB",
            "state": "IL",
            "postal_code": "601155905",
            "telephone_number": "815-787-6700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1625 BETHANY RD",
            "city": "SYCAMORE",
            "state": "IL",
            "postal_code": "601783124",
            "telephone_number": "815-758-8400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VALENTINER",
        "first_name": "DAVID",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-04-20",
        "last_updated": "2016-04-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "071005897",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sycamore, IL

Sources for this page

Verify at the official NPI Registry.