Individual
JOANNE RUTH PELLETIER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
19 GREENRIDGE AVENUE, ANDRUS CHILDREN'S CENTER MENTAL HEALTH DIVISION, WHITE PLAINS, NY 10605
(914) 949-7680
Mailing address
1156 NORTH BROADWAY, ANDRUS CHILDREN'S CENTER, YONKERS, NY 10701-1108
(914) 965-3700
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
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