Provider Demographics
NPI:1861458457
Name:VONRAFFAY, VALERIE R (PHD)
Entity Type:Individual
Prefix:DR
First Name:VALERIE
Middle Name:R
Last Name:VONRAFFAY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12335 SANTA MONICA BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025
Mailing Address - Country:US
Mailing Address - Phone:310-275-2183
Mailing Address - Fax:
Practice Address - Street 1:450 N BEDFORD DRIVE
Practice Address - Street 2:SUITE 312
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210
Practice Address - Country:US
Practice Address - Phone:310-275-2183
Practice Address - Fax:310-828-5657
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-24
Last Update Date:2007-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY15067103TC0700X
103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY150670Medicaid
CP15067Medicare ID - Type Unspecified
S61185Medicare UPIN