Provider Demographics
NPI:1639352156
Name:PHEANIS, VALERIE (LCSW, MT-BC, CHN)
Entity type:Individual
Prefix:
First Name:VALERIE
Middle Name:
Last Name:PHEANIS
Suffix:
Gender:F
Credentials:LCSW, MT-BC, CHN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31-06 GENTNER RD
Mailing Address - Street 2:
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-4546
Mailing Address - Country:US
Mailing Address - Phone:973-768-8662
Mailing Address - Fax:
Practice Address - Street 1:31-06 GENTNER RD
Practice Address - Street 2:
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-4546
Practice Address - Country:US
Practice Address - Phone:973-768-8662
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-06
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC054483001041C0700X, 1041C0700X
NJ44SL05505200104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker