Healthcare Provider Details

I. General information

NPI: 1336675768
Provider Name (Legal Business Name): VALERIE MARIE VORDERSTRASSE PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2017
Last Update Date: 12/08/2022
Certification Date: 12/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1130 TEN ROD RD STE C205D
NORTH KINGSTOWN RI
02852-4167
US

IV. Provider business mailing address

242 LAUREL RIDGE LN
NORTH KINGSTOWN RI
02852-4151
US

V. Phone/Fax

Practice location:
  • Phone: 401-329-6336
  • Fax:
Mailing address:
  • Phone: 860-255-8115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number10808-PY-PR
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPS01631
License Number StateRI
# 3
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number10808-PY-PR
License Number StateMA
# 4
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number2014014302
License Number StateMO
# 5
Primary TaxonomyY
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License NumberPS01631
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: