Active NPI
Valencia Lenaa Agnew, PHD
- Psychologist
- Grand Rapids, MI
National Provider Identifier
1851473839
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 6301011046
- Practice address
- 3501 Lake Eastbrook Blvd SE
Suite 258
Grand Rapids, MI 49546-5938 - Phone
- (616) 719-0194
- Fax
- (800) 219-5205
- NPI assigned
- Oct 19, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 6301011046 | MI | Primary |
| Psychologist | 103T00000X | 6301015520 | MI |
Addresses
Primary practice location
3501 Lake Eastbrook Blvd SE
Suite 258
Grand Rapids, MI 49546-5938
Mailing address
3501 Lake Eastbrook Blvd SE
Suite 258
Grand Rapids, MI 49546-5938
Phone (616) 719-0194
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6301011046 | MI | MD | Psychologist |
| 6301015520 | MI | MD | Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Adolescent and Family Behavioral Health Services | Psychologist | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Psychologist
- Grand Rapids, MI
- NPI 1184054652
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161216000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1389744000000",
"number": "1851473839",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3501 LAKE EASTBROOK BLVD SE",
"address_2": "SUITE 258",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495465938",
"telephone_number": "616-719-0194",
"fax_number": "800-219-5205"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3501 LAKE EASTBROOK BLVD SE",
"address_2": "SUITE 258",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495465938",
"telephone_number": "616-719-0194",
"fax_number": "800-219-5205"
}
],
"practiceLocations": [],
"basic": {
"last_name": "AGNEW",
"first_name": "VALENCIA",
"middle_name": "LENAA",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-10-19",
"last_updated": "2014-01-15",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "MI",
"license": "6301011046",
"primary": true
},
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "MI",
"license": "6301015520",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Grand Rapids, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.