Provider Demographics
NPI:1720295918
Name:PELTIER, MARY CATHERINE
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:CATHERINE
Last Name:PELTIER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9079 CALLE LUCIA
Mailing Address - Street 2:
Mailing Address - City:LAKESIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92040-5002
Mailing Address - Country:US
Mailing Address - Phone:619-337-3830
Mailing Address - Fax:619-337-3610
Practice Address - Street 1:2315 BAR BIT RD
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:CA
Practice Address - Zip Code:91978-1901
Practice Address - Country:US
Practice Address - Phone:619-337-3830
Practice Address - Fax:619-337-3610
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)