Provider Demographics
NPI:1952736738
Name:BAGBY-YOUNG, VALENCIA L (EDD PSYCHOLOGY)
Entity Type:Individual
Prefix:DR
First Name:VALENCIA
Middle Name:L
Last Name:BAGBY-YOUNG
Suffix:
Gender:F
Credentials:EDD PSYCHOLOGY
Other - Prefix:
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Mailing Address - Street 1:31 BURNWOOD DRIVE
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06002-2264
Mailing Address - Country:US
Mailing Address - Phone:860-604-6914
Mailing Address - Fax:860-242-1811
Practice Address - Street 1:41 N MAIN ST STE 302
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06107-1929
Practice Address - Country:US
Practice Address - Phone:860-236-7333
Practice Address - Fax:203-439-2087
Is Sole Proprietor?:No
Enumeration Date:2013-09-11
Last Update Date:2019-07-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT003280103T00000X, 103TC1900X, 103TP2701X
CT7986363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy