| Doctor Name: | VICTOR J PETRELLA |
| NPI Number: | 1437217221 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | RNCS |
| License Number: | 162890 |
| Business Practice Address: | Fairview Commons 151 Christian Hill Road Great Barrington, MA - 01230 |
| Business Phone Number: | 4135284560 |
| Business Fax Number: | |
| Mailing Address: | 725 North St, Primary Care Outreach Team PITTSFIELD |
| State: | MA |
| Postal Code: | 012014109 |
| Phone Number: | 4134472617 |
| Fax Number: | 4134472176 |
| NPI Enumeration Date: | 12/05/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 364SP0809X |
| License Number: | 162890 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Clinical Nurse Specialist |
| Taxonomy Specialization: | Psych/Mental Health, Adult |
| Taxonomy Definition: | |