Provider Demographics
NPI:1790272052
Name:PEER ALLIANCE LEAGUE
Entity Type:Organization
Organization Name:PEER ALLIANCE LEAGUE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:KATE
Authorized Official - Middle Name:
Authorized Official - Last Name:HEWLETT
Authorized Official - Suffix:
Authorized Official - Credentials:NYCPS
Authorized Official - Phone:607-353-9751
Mailing Address - Street 1:PO BOX 1183
Mailing Address - Street 2:
Mailing Address - City:ONEONTA
Mailing Address - State:NY
Mailing Address - Zip Code:13820-5183
Mailing Address - Country:US
Mailing Address - Phone:607-353-9751
Mailing Address - Fax:
Practice Address - Street 1:139 RIVER ST
Practice Address - Street 2:
Practice Address - City:ONEONTA
Practice Address - State:NY
Practice Address - Zip Code:13820-2237
Practice Address - Country:US
Practice Address - Phone:607-353-9751
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-21
Last Update Date:2018-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health