Provider Demographics
NPI:1922783273
Name:VALLIERES, JENNIFER MEGAN (LPC)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:MEGAN
Last Name:VALLIERES
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MISS
Other - First Name:JENNIFER
Other - Middle Name:MEGAN
Other - Last Name:PALOMBA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:221 MARYWATERSFORD RD
Mailing Address - Street 2:
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004-2002
Mailing Address - Country:US
Mailing Address - Phone:307-699-4950
Mailing Address - Fax:
Practice Address - Street 1:221 MARYWATERSFORD RD
Practice Address - Street 2:
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-2002
Practice Address - Country:US
Practice Address - Phone:307-699-4950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-15
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC010153101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional