Provider Demographics
NPI:1407095474
Name:VALASEK, ADELL M
Entity Type:Individual
Prefix:MRS
First Name:ADELL
Middle Name:M
Last Name:VALASEK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:162 ATSION RD
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08055-1311
Mailing Address - Country:US
Mailing Address - Phone:609-654-1525
Mailing Address - Fax:
Practice Address - Street 1:162 ATSION RD
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:NJ
Practice Address - Zip Code:08055-1311
Practice Address - Country:US
Practice Address - Phone:609-654-1525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-13
Last Update Date:2009-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1-05-2579103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst