Individual
JOANNE RUTH PELLETIER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00355940
AGENCY MEDICAID PROVIDER ID
NY
01
—
1285628552
AGENCY NPI#
NY
01
—
WVE061
AGENCY MEDICARE ID #
NY
Enumeration date
07/19/2010
Last updated
07/19/2010
Update your record
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