MEDICARE: DR. VALDEA DELANO JENNINGS ED.D

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	103TC2200X	Clinical Child & Adolescent Psychologist	PS000363L	PA
2	103TH0100X	Health Service Psychologist	PS000363L	PA

General Provider Information

NPI Number	:	1487707006
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VALDEA DELANO JENNINGS ED.D

Provider Business Mailing Address
First Line	:	333 W MOUNT AIRY AVE
Second Line	:
City	:	PHILA
State	:	PA
Zip	:	19119-2941
Country	:	US
Telephone Number	:	215-248-5228
Fax Number	:

Provider Business Practice Location Address
First Line	:	333 W MOUNT AIRY AVE
Second Line	:
City	:	PHILA
State	:	PA
Zip	:	19119-2941
Country	:	US
Telephone Number	:	215-248-5228
Fax Number	:

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

Provider Enumeration Date	:	01/18/2007
Last Update Date	:	09/11/2025

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