# DAVID PERADOTTO

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1043249469
- **Gender:** Man
- **Credential:** PHD

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 103TC2200X | Clinical Child & Adolescent Psychologist | 6301008098 | MI | Yes |

## Other

- **Enumeration date:** 06/30/2006
- **Last updated:** 08/21/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 273178 | BCN PIN | MI |
| 01 | — | 300040030 | NPC TAX ID | MI |
| 01 | — | 680F321030 | BC PIN | MI |
| 01 | — | 680F333060 | BC PIN | MI |