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General NPI Number Information
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NPI Number | 1811223134
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Entity Type | Individual
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Provider Name | STELLA PETRONDA PSY.D
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Gender | Female
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Dates
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Enumeration Date | 10/21/2009
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Last Update Date | 10/21/2009
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Provider Practice Location Address
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Address Line | 25 MAIN STREET SUITE 208
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City | STOCKBRIDGE
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State | MA
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Zip | 01262
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Country | US
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Telephone | 413-931-5214
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Fax |
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Provider Business Mailing Address
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Address Line | 1112 NORTH ST APT 1
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City | PITTSFIELD
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State | MA
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Zip | 01201-1557
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Country | US
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Telephone | 413-553-3165
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 9017
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License Number State | MA
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