Provider Demographics
NPI:1619070737
Name:DRAKE, VALERIE ANNE (MA)
Entity Type:Individual
Prefix:MRS
First Name:VALERIE
Middle Name:ANNE
Last Name:DRAKE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:VALERIE
Other - Middle Name:ANNE
Other - Last Name:WONSANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:149 DURHAM RD STE 26
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:CT
Mailing Address - Zip Code:06443-2664
Mailing Address - Country:US
Mailing Address - Phone:203-208-8750
Mailing Address - Fax:203-421-6743
Practice Address - Street 1:149 DURHAM RD STE 26
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:CT
Practice Address - Zip Code:06443-2664
Practice Address - Country:US
Practice Address - Phone:203-208-8750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2019-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT09-161221700000X
CT2262101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt TherapistGroup - Single Specialty