Provider Demographics
NPI:1033449798
Name:LADD, PETER DORIAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:DORIAN
Last Name:LADD
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 184
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:NY
Mailing Address - Zip Code:13624-0184
Mailing Address - Country:US
Mailing Address - Phone:315-228-3671
Mailing Address - Fax:315-686-0026
Practice Address - Street 1:38047 WINDWARD CLIFFS LANE
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:NY
Practice Address - Zip Code:13624-0184
Practice Address - Country:US
Practice Address - Phone:315-228-3671
Practice Address - Fax:315-686-0026
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-31
Last Update Date:2009-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0003576-1103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling