Provider Demographics
NPI:1649820739
Name:PETRUS, PAULA LYNN (LMHC, LPC)
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:LYNN
Last Name:PETRUS
Suffix:
Gender:F
Credentials:LMHC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 OLD CORNER RD
Mailing Address - Street 2:
Mailing Address - City:POUND RIDGE
Mailing Address - State:NY
Mailing Address - Zip Code:10576-1627
Mailing Address - Country:US
Mailing Address - Phone:914-234-6757
Mailing Address - Fax:
Practice Address - Street 1:12 OLD CORNER RD
Practice Address - Street 2:
Practice Address - City:POUND RIDGE
Practice Address - State:NY
Practice Address - Zip Code:10576-1627
Practice Address - Country:US
Practice Address - Phone:914-262-2996
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-19
Last Update Date:2019-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3864101YP2500X
NY011442101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional