Provider Demographics
NPI:1336675768
Name:VORDERSTRASSE, VALERIE MARIE (PSYD)
Entity type:Individual
Prefix:DR
First Name:VALERIE
Middle Name:MARIE
Last Name:VORDERSTRASSE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:242 LAUREL RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:NORTH KINGSTOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02852-4151
Mailing Address - Country:US
Mailing Address - Phone:860-255-8115
Mailing Address - Fax:
Practice Address - Street 1:1130 TEN ROD RD STE C205D
Practice Address - Street 2:
Practice Address - City:NORTH KINGSTOWN
Practice Address - State:RI
Practice Address - Zip Code:02852-4167
Practice Address - Country:US
Practice Address - Phone:401-329-6336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-04
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10808-PY-PR103TM1800X, 103TC2200X
MO2014014302103TM1800X
RIPS01631103TC2200X, 103TM1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent