Provider Demographics
NPI:1033758248
Name:PASTOLOVE, RENEE SUSAN (MS, ATR-BC, LCAT)
Entity Type:Individual
Prefix:MS
First Name:RENEE
Middle Name:SUSAN
Last Name:PASTOLOVE
Suffix:
Gender:F
Credentials:MS, ATR-BC, LCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:153 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT KISCO
Mailing Address - State:NY
Mailing Address - Zip Code:10549-2317
Mailing Address - Country:US
Mailing Address - Phone:914-469-7117
Mailing Address - Fax:
Practice Address - Street 1:153 E MAIN ST STE F3
Practice Address - Street 2:
Practice Address - City:MOUNT KISCO
Practice Address - State:NY
Practice Address - Zip Code:10549-2319
Practice Address - Country:US
Practice Address - Phone:914-469-7117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-06
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001776221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist