MEDICARE: DR. RENAN U. ERKUT-PETERMANN PH.D.

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
1	101YM0800X	Mental Health Counselor	003379-1	NY
2	103TC0700X	Clinical Psychologist	35S100701700	NJ

General Provider Information

NPI Number	:	1750429817
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RENAN U. ERKUT-PETERMANN PH.D.

Provider Business Mailing Address
First Line	:	15 CENTRAL AVENUE
Second Line	:
City	:	DEMAREST
State	:	NJ
Zip	:	07627-1602
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	266 HARRISTOWN RD STE 209
Second Line	:
City	:	GLEN ROCK
State	:	NJ
Zip	:	07452-3321
Country	:	US
Telephone Number	:	201-564-7331
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/02/2007
Last Update Date	:	03/10/2023

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