Healthcare Provider Details

I. General information

NPI: 1619954864
Provider Name (Legal Business Name): STEVEN J ADELMAN PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 W JASPER ST
VERSAILLES MO
65084-1020
US

IV. Provider business mailing address

PO BOX 21
VERSAILLES MO
65084-0021
US

V. Phone/Fax

Practice location:
  • Phone: 573-378-6833
  • Fax: 573-378-6823
Mailing address:
  • Phone: 573-378-6833
  • Fax: 573-378-6823

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License NumberR0513
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: