# WELL CHILD PSYCHIATRIC NP PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1508514340
- **Authorized official:** DEBBRA PEDERSEN (CREDENTIALING SPECIALIST)
- **Authorized official phone:** (518) 631-8268

## Contact information

- **Practice address:** 92 BROAD ST FL 2, GLENS FALLS, NY 12801-4383
- **Practice address phone:** (518) 480-4002
- **Mailing address:** 92 BROAD ST FL 2, GLENS FALLS, NY 12801-4383
- **Mailing address phone:** (518) 480-4002

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | NULL | Yes |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 03/11/2022
- **Last updated:** 03/11/2022