Healthcare Provider Details

I. General information

NPI: 1568609865
Provider Name (Legal Business Name): STEPHEN K. VALLE SC.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2009
Last Update Date: 01/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

181 N COMMON ST
LYNN MA
01905-2506
US

IV. Provider business mailing address

181 N COMMON ST
LYNN MA
01905-2506
US

V. Phone/Fax

Practice location:
  • Phone: 617-257-1259
  • Fax: 781-596-0663
Mailing address:
  • Phone: 617-257-1259
  • Fax: 781-596-0663

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1957
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number1957
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: