Provider Demographics
NPI:1700850278
Name:WITHERSPOON, VALERIE (PHD, RN, CS)
Entity type:Individual
Prefix:
First Name:VALERIE
Middle Name:
Last Name:WITHERSPOON
Suffix:
Gender:F
Credentials:PHD, RN, CS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5000 OVERLAND AVE
Mailing Address - Street 2:8
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90230-4995
Mailing Address - Country:US
Mailing Address - Phone:310-838-2738
Mailing Address - Fax:310-838-2729
Practice Address - Street 1:5000 OVERLAND AVE
Practice Address - Street 2:8
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90230-4995
Practice Address - Country:US
Practice Address - Phone:310-838-2738
Practice Address - Fax:310-838-2729
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY13838103T00000X
CA319821364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
R16772Medicare UPIN
WCP13838AMedicare PIN