MEDICARE: MRS. VALERIE ANNE DRAKE MA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	221700000X	Art Therapist	09-161	CT
2	101YP2500X	Professional Counselor	2262	CT

General Provider Information

NPI Number	:	1619070737
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. VALERIE ANNE DRAKE MA

Provider Business Mailing Address
First Line	:	149 DURHAM RD STE 26
Second Line	:
City	:	MADISON
State	:	CT
Zip	:	06443-2664
Country	:	US
Telephone Number	:	203-208-8750
Fax Number	:	203-421-6743

Provider Business Practice Location Address
First Line	:	149 DURHAM RD STE 26
Second Line	:
City	:	MADISON
State	:	CT
Zip	:	06443-2664
Country	:	US
Telephone Number	:	203-208-8750
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/06/2006
Last Update Date	:	06/05/2019

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