Provider Demographics
NPI:1417522640
Name:PETRUS, VIRGINIE (LMHC)
Entity Type:Individual
Prefix:
First Name:VIRGINIE
Middle Name:
Last Name:PETRUS
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 STONE PL STE 305
Mailing Address - Street 2:
Mailing Address - City:BRONXVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10708-3427
Mailing Address - Country:US
Mailing Address - Phone:646-481-1374
Mailing Address - Fax:
Practice Address - Street 1:1 STONE PL STE 305
Practice Address - Street 2:
Practice Address - City:BRONXVILLE
Practice Address - State:NY
Practice Address - Zip Code:10708-3427
Practice Address - Country:US
Practice Address - Phone:646-481-1374
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-20
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY101Y00000X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor