Doctor Name: | JANNINE M PERGOLA |
NPI Number: | 1174632871 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.S, LMHC |
License Number: | 000123-1 |
Business Practice Address: | 11 Sammis St Saint James, NY - 117801628 |
Business Phone Number: | 6318628164 |
Business Fax Number: | |
Mailing Address: | 11 Sammis St, SAINT JAMES |
State: | NY |
Postal Code: | 117801628 |
Phone Number: | 6318628164 |
Fax Number: | |
NPI Enumeration Date: | 08/29/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | 000123-1 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NY |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |