Provider Demographics
NPI:1336518471
Name:VALE PSYCHOLOGY GROUP
Entity Type:Organization
Organization Name:VALE PSYCHOLOGY GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:M
Authorized Official - Last Name:VALE
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:310-916-6217
Mailing Address - Street 1:6447 ORANGE ST
Mailing Address - Street 2:APT 107
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-4758
Mailing Address - Country:US
Mailing Address - Phone:310-916-6217
Mailing Address - Fax:
Practice Address - Street 1:153 S LASKY DR
Practice Address - Street 2:#3
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-1721
Practice Address - Country:US
Practice Address - Phone:310-916-6217
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-18
Last Update Date:2015-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY27080103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty