Provider Demographics
NPI:1760836191
Name:PETOUVIS, LINDSAY (PSYD)
Entity Type:Individual
Prefix:DR
First Name:LINDSAY
Middle Name:
Last Name:PETOUVIS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:769 SUSQUEHANNA AVE
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN LAKES
Mailing Address - State:NJ
Mailing Address - Zip Code:07417-1321
Mailing Address - Country:US
Mailing Address - Phone:201-891-8154
Mailing Address - Fax:
Practice Address - Street 1:769 SUSQUEHANNA AVE
Practice Address - Street 2:
Practice Address - City:FRANKLIN LAKES
Practice Address - State:NJ
Practice Address - Zip Code:07417-1321
Practice Address - Country:US
Practice Address - Phone:201-891-8154
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-22
Last Update Date:2017-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00541300103T00000X
NY020818-1103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist