Provider Demographics
NPI:1396775177
Name:VALLIERE, VERONIQUE NICOLE (PSYD)
Entity type:Individual
Prefix:DR
First Name:VERONIQUE
Middle Name:NICOLE
Last Name:VALLIERE
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 1:726 CHURCH STREET
Mailing Address - Street 2:
Mailing Address - City:FOGELSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18051-0864
Mailing Address - Country:US
Mailing Address - Phone:610-530-8392
Mailing Address - Fax:610-530-8940
Practice Address - Street 1:726 CHURCH STREET
Practice Address - Street 2:
Practice Address - City:FOGELSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18051-0864
Practice Address - Country:US
Practice Address - Phone:610-530-8392
Practice Address - Fax:610-530-8940
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS007952L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA890469Medicare PIN