Provider Demographics
NPI:1457541914
Name:STEFANOF, VALERIE H (MA LLP)
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:H
Last Name:STEFANOF
Suffix:
Gender:F
Credentials:MA LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5641 6 MILE RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH LYON
Mailing Address - State:MI
Mailing Address - Zip Code:48178-9641
Mailing Address - Country:US
Mailing Address - Phone:248-437-7272
Mailing Address - Fax:
Practice Address - Street 1:5641 6 MILE RD
Practice Address - Street 2:
Practice Address - City:SOUTH LYON
Practice Address - State:MI
Practice Address - Zip Code:48178-9641
Practice Address - Country:US
Practice Address - Phone:248-437-7272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-30
Last Update Date:2011-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301010764103TM1800X
MI6802060120104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities