Provider Demographics
NPI:1013003920
Name:PEPPER, RENEE
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:
Last Name:PEPPER
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 1:8 STOCKBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT KISCO
Mailing Address - State:NY
Mailing Address - Zip Code:10549-4521
Mailing Address - Country:US
Mailing Address - Phone:914-241-4240
Mailing Address - Fax:914-241-4239
Practice Address - Street 1:8 STOCKBRIDGE ROAD
Practice Address - Street 2:
Practice Address - City:MOUNT KISCO
Practice Address - State:NY
Practice Address - Zip Code:10549-4521
Practice Address - Country:US
Practice Address - Phone:914-241-4240
Practice Address - Fax:914-241-4239
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR046814-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP1467668OtherOXFORD
NY02690811Medicaid
NY02690811Medicaid