Provider Demographics
NPI:1518211101
Name:EVANS, VALERIE A (PHD)
Entity type:Individual
Prefix:
First Name:VALERIE
Middle Name:A
Last Name:EVANS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:319 QUEEN ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19147-3220
Mailing Address - Country:US
Mailing Address - Phone:267-979-5136
Mailing Address - Fax:
Practice Address - Street 1:1277 WYOMING AVE
Practice Address - Street 2:
Practice Address - City:EXETER
Practice Address - State:PA
Practice Address - Zip Code:18643-1435
Practice Address - Country:US
Practice Address - Phone:570-654-8000
Practice Address - Fax:570-654-8002
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-03
Last Update Date:2012-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH000003103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst