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NPI Code Detail

MEDICARE: VALERIE WARDLAW PSYD

MEDICARE: VALERIE WARDLAW PSYD
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
1101Y00000XCounselor

General Provider Information

NPI Number : 1497142905
Entity Type Code : Individual
Provider Name (Legal Business Name) : VALERIE WARDLAW PSYD
Provider Business Mailing Address
First Line : 267 S MADISON AVE APT 202
Second Line :
City : PASADENA
State : CA
Zip : 91101-2899
Country : US
Telephone Number : 626-354-4885
Fax Number :
Provider Business Practice Location Address
First Line : 200 OCEANGATE
Second Line : SUITE 100
City : LONG BEACH
State : CA
Zip : 90802-4302
Country : US
Telephone Number : 626-354-4885
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/22/2015
Last Update Date : 04/22/2015

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Directions to “ VALERIE WARDLAW PSYD” Practice Location

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