MEDICARE: DR. ANDREA M VALERIO PH.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	103TC0700X	Clinical Psychologist	0810-001570	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	071282	OTHER	VA	ANTHEM BC/BS

General Provider Information

NPI Number	:	1861448284
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANDREA M VALERIO PH.D.

Provider Business Mailing Address
First Line	:	2100 SHERBROOKE CIR
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23454-2203
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2100 SHERBROOKE CIR
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23454-2203
Country	:	US
Telephone Number	:	757-481-7800
Fax Number	:	757-481-4126

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

Provider Enumeration Date	:	05/26/2006
Last Update Date	:	07/08/2007

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