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NPI Code Detail

MEDICARE: MARY CATHERINE PELTIER

MEDICARE: MARY CATHERINE PELTIER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number : 1720295918
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY CATHERINE PELTIER
Provider Business Mailing Address
First Line : 9079 CALLE LUCIA
Second Line :
City : LAKESIDE
State : CA
Zip : 92040-5002
Country : US
Telephone Number : 619-337-3830
Fax Number : 619-337-3610
Provider Business Practice Location Address
First Line : 2315 BAR BIT RD
Second Line :
City : SPRING VALLEY
State : CA
Zip : 91978-1901
Country : US
Telephone Number : 619-337-3830
Fax Number : 619-337-3610
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/17/2007
Last Update Date : 06/03/2016

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Directions to “ MARY CATHERINE PELTIER ” Practice Location

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