Provider Demographics
NPI:1790405256
Name:ADOMAITIS, VALERIE ROSE (LPC-A)
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:ROSE
Last Name:ADOMAITIS
Suffix:
Gender:F
Credentials:LPC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:567 VAUXHALL STREET EXT STE 122
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06385-4332
Mailing Address - Country:US
Mailing Address - Phone:860-917-0790
Mailing Address - Fax:
Practice Address - Street 1:567 VAUXHALL STREET EXT STE 122
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:CT
Practice Address - Zip Code:06385-4332
Practice Address - Country:US
Practice Address - Phone:860-917-0790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-02
Last Update Date:2022-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT5710101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional