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General NPI Number Information
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NPI Number | 1902645633
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Entity Type | Organization
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Legal Business Name | OFFICE OF VIRGINIE PETRUS MENTAL HEALTH COUNSELOR PLLC
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Dates
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Enumeration Date | 05/22/2024
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Last Update Date | 05/22/2024
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Provider Practice Location Address
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Address Line | 260 MADISON AVE FL 8
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City | NEW YORK
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State | NY
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Zip | 10016-2418
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Country | US
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Telephone | 646-481-1374
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Fax |
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Provider Business Mailing Address
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Address Line | 110 IRON PIER DR APT 336
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City | SYRACUSE
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State | NY
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Zip | 13204-1196
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Country | US
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Telephone | 862-250-2955
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | PETRUS VIRGINIE
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Credential | LMHC
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Telephone | 862-250-2955
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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