Provider Demographics
NPI:1497142905
Name:WARDLAW, VALERIE (PSYD)
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:
Last Name:WARDLAW
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 1:267 S MADISON AVE APT 202
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-2899
Mailing Address - Country:US
Mailing Address - Phone:626-354-4885
Mailing Address - Fax:
Practice Address - Street 1:200 OCEANGATE
Practice Address - Street 2:SUITE 100
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90802-4302
Practice Address - Country:US
Practice Address - Phone:626-354-4885
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-22
Last Update Date:2015-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor