Provider Demographics
NPI:1558629741
Name:PETRECA, VICTOR GONCALVES (PMHNP)
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:GONCALVES
Last Name:PETRECA
Suffix:
Gender:M
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 FIELDSTONE LN
Mailing Address - Street 2:
Mailing Address - City:NATICK
Mailing Address - State:MA
Mailing Address - Zip Code:01760-5560
Mailing Address - Country:US
Mailing Address - Phone:617-470-9990
Mailing Address - Fax:
Practice Address - Street 1:13 FIELDSTONE LN
Practice Address - Street 2:
Practice Address - City:NATICK
Practice Address - State:MA
Practice Address - Zip Code:01760-5560
Practice Address - Country:US
Practice Address - Phone:617-470-9990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-25
Last Update Date:2013-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2277278163WP0808X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health