Provider Demographics
NPI:1699842344
Name:VALLANDINGHAM, BRENDA KAY (MA)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:KAY
Last Name:VALLANDINGHAM
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:PO BOX 1944
Mailing Address - Street 2:
Mailing Address - City:LENOX
Mailing Address - State:MA
Mailing Address - Zip Code:01240-4944
Mailing Address - Country:US
Mailing Address - Phone:413-232-3016
Mailing Address - Fax:
Practice Address - Street 1:21 OLANDER DR
Practice Address - Street 2:
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-3631
Practice Address - Country:US
Practice Address - Phone:413-442-4003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2019-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6359101YM0800X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA34361OtherHEALTH NEW ENGLAND