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General NPI Number Information
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NPI Number | 1396042206
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Entity Type | Individual
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Provider Name | PAUL PELLETREAU LCSW
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Gender | Male
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Dates
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Enumeration Date | 02/13/2011
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Last Update Date | 02/13/2011
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Provider Practice Location Address
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Address Line | 4236 59TH ST W 4236 59TH STREET WEST
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City | BRADENTON
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State | FL
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Zip | 34209-6664
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Country | US
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Telephone | 941-794-6617
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Fax | 941-795-7536
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Provider Business Mailing Address
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Address Line | PO BOX 4268 319 TARPON STREET P.O. BOX 4268
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City | ANNA MARIA
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State | FL
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Zip | 34216-4268
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Country | US
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Telephone | 941-778-7402
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SW 3086
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License Number State | FL
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