Provider Demographics
NPI:1619954864
Name:ADELMAN, STEVEN J (PSYD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:J
Last Name:ADELMAN
Suffix:
Gender:M
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:PO BOX 21
Mailing Address - Street 2:
Mailing Address - City:VERSAILLES
Mailing Address - State:MO
Mailing Address - Zip Code:65084-0021
Mailing Address - Country:US
Mailing Address - Phone:573-378-6833
Mailing Address - Fax:573-378-6823
Practice Address - Street 1:108 W JASPER ST
Practice Address - Street 2:
Practice Address - City:VERSAILLES
Practice Address - State:MO
Practice Address - Zip Code:65084-1020
Practice Address - Country:US
Practice Address - Phone:573-378-6833
Practice Address - Fax:573-378-6823
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR0513103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral