Provider Demographics
NPI:1740319730
Name:VALOVAGE, MAUREEN M (LMFT)
Entity type:Individual
Prefix:MS
First Name:MAUREEN
Middle Name:M
Last Name:VALOVAGE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7041 KINGDOM RD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:NY
Mailing Address - Zip Code:13112-8702
Mailing Address - Country:US
Mailing Address - Phone:315-689-7636
Mailing Address - Fax:
Practice Address - Street 1:12 W GENESEE ST
Practice Address - Street 2:
Practice Address - City:BALDWINSVILLE
Practice Address - State:NY
Practice Address - Zip Code:13027-1105
Practice Address - Country:US
Practice Address - Phone:315-638-2505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY48106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist