Basic Information
Provider Information
NPI: 1710082953
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: NABOLOTNY
FirstName: VALERIA
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: PSY.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 8170 MCCORMICK BLVD
Address2: #204 C/O DAVKEN
City: SKOKIE
State: IL
PostalCode: 600762961
CountryCode: US
TelephoneNumber: 8476730718
FaxNumber: 8476730875
Practice Location
Address1: 8170 MCCORMICK BLVD
Address2: #204 C/O DAVKEN
City: SKOKIE
State: IL
PostalCode: 600762961
CountryCode: US
TelephoneNumber: 8476730718
FaxNumber: 8476730875
Other Information
ProviderEnumerationDate: 09/13/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
103TC0700X ILY Behavioral Health & Social Service ProvidersPsychologistClinical

No ID Information.


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