Provider Demographics
NPI:1366437691
Name:PEARSON, VALERIE JAY (PHD)
Entity type:Individual
Prefix:
First Name:VALERIE
Middle Name:JAY
Last Name:PEARSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:426 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-4206
Mailing Address - Country:US
Mailing Address - Phone:619-804-8044
Mailing Address - Fax:760-489-8700
Practice Address - Street 1:426 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-4206
Practice Address - Country:US
Practice Address - Phone:619-804-8044
Practice Address - Fax:760-489-8700
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2016-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY14889103TA0400X, 103TB0200X, 103TC0700X, 103TP2701X, 103TR0400X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
No103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5883430OtherMEDI CAL IDENTIFIER
CA148890Medicare ID - Type Unspecified