| Doctor Name: | DR. KENNETH R. PELLETIER |
| NPI Number: | 1184748014 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PHD, MD(HC) |
| License Number: | PSY4631 |
| Business Practice Address: | 5 Country Oak Ln Alamo, CA - 945072854 |
| Business Phone Number: | 9259327074 |
| Business Fax Number: | 9258383007 |
| Mailing Address: | 5 Country Oak Ln, ALAMO |
| State: | CA |
| Postal Code: | 945072854 |
| Phone Number: | 9259327074 |
| Fax Number: | 9258383007 |
| NPI Enumeration Date: | 03/17/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103G00000X |
| License Number: | PSY4631 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Clinical Neuropsychologist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual with a doctorate degree, licensure in clinical psychology and specialized training or board certification in neuropsychology who practices or adheres to the principles of neuropsychology; a specialty within the field of psychology focusing primarily on neurobehavioral functioning. |