Provider Demographics
NPI:1942395843
Name:VALLELY, MARIE BRIDGET (RNCS,LMFT, CASAC)
Entity Type:Individual
Prefix:MS
First Name:MARIE
Middle Name:BRIDGET
Last Name:VALLELY
Suffix:
Gender:F
Credentials:RNCS,LMFT, CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 SEASIDE AVE
Mailing Address - Street 2:PO BOX 1000
Mailing Address - City:DENNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02638
Mailing Address - Country:US
Mailing Address - Phone:508-385-9376
Mailing Address - Fax:
Practice Address - Street 1:113 SEASIDE AVE
Practice Address - Street 2:
Practice Address - City:DENNIS
Practice Address - State:MA
Practice Address - Zip Code:02638
Practice Address - Country:US
Practice Address - Phone:508-385-9376
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA189102364SP0810X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0810XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Child & Family