Provider Demographics
NPI:1992077044
Name:PIERROT, MARYBETH
Entity type:Individual
Prefix:MRS
First Name:MARYBETH
Middle Name:
Last Name:PIERROT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14379 ROUTE 9W
Mailing Address - Street 2:CIRCLE OF FRIENDS
Mailing Address - City:RAVENA
Mailing Address - State:NY
Mailing Address - Zip Code:12143
Mailing Address - Country:US
Mailing Address - Phone:518-756-3124
Mailing Address - Fax:518-756-9476
Practice Address - Street 1:14379 ROUTE 9W
Practice Address - Street 2:CIRCLE OF FRIENDS
Practice Address - City:RAVENA
Practice Address - State:NY
Practice Address - Zip Code:12143-9602
Practice Address - Country:US
Practice Address - Phone:518-756-3124
Practice Address - Fax:518-756-9476
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-06
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1376654103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool