Provider Demographics
NPI:1285848556
Name:VALLONE, PETER PHILP JR (PHD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:PHILP
Last Name:VALLONE
Suffix:JR
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3325 EAGLE CT
Mailing Address - Street 2:
Mailing Address - City:CHIPLEY
Mailing Address - State:FL
Mailing Address - Zip Code:32428-5697
Mailing Address - Country:US
Mailing Address - Phone:185-032-6074
Mailing Address - Fax:
Practice Address - Street 1:3325 EAGLE CT
Practice Address - Street 2:
Practice Address - City:CHIPLEY
Practice Address - State:FL
Practice Address - Zip Code:32428-5697
Practice Address - Country:US
Practice Address - Phone:185-032-6074
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health