Provider Demographics
NPI:1679790067
Name:STEAD, VALJEAN MARIE (MA)
Entity Type:Individual
Prefix:
First Name:VALJEAN
Middle Name:MARIE
Last Name:STEAD
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 HARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:CHRISTIANA
Mailing Address - State:PA
Mailing Address - Zip Code:17509-1208
Mailing Address - Country:US
Mailing Address - Phone:610-593-7336
Mailing Address - Fax:
Practice Address - Street 1:91 NEWPORT PIKE
Practice Address - Street 2:SUITE 301
Practice Address - City:GAP
Practice Address - State:PA
Practice Address - Zip Code:17527-9579
Practice Address - Country:US
Practice Address - Phone:717-442-8663
Practice Address - Fax:717-442-8663
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS006307L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0762153000OtherPERSONAL CHOICE
PA2927990OtherAETNA
PAN6U95OtherEMPIRE BCBS
PA2927989OtherAETNA