Healthcare Provider Details

I. General information

NPI: 1851653695
Provider Name (Legal Business Name): PATRICIA PEBLEY PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2012
Last Update Date: 07/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 SCIENCE PARK
NEW HAVEN CT
06511-1966
US

IV. Provider business mailing address

5 SCIENCE PARK
NEW HAVEN CT
06511-1966
US

V. Phone/Fax

Practice location:
  • Phone: 203-777-8648
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: