MEDICARE: MRS. MARYBETH F PETERSON PMHNP

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	F401516-1	NY

General Provider Information

NPI Number	:	1467748525
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARYBETH F PETERSON PMHNP

Provider Business Mailing Address
First Line	:	7498 OLD BIG CREEK RD
Second Line	:
City	:	HORNELL
State	:	NY
Zip	:	14843-9135
Country	:	US
Telephone Number	:	607-324-4044
Fax Number	:

Provider Business Practice Location Address
First Line	:	955 YONKERS AVE STE 102
Second Line	:
City	:	YONKERS
State	:	NY
Zip	:	10704-3062
Country	:	US
Telephone Number	:	347-667-7924
Fax Number	:	332-262-2396

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

Provider Enumeration Date	:	06/27/2011
Last Update Date	:	11/05/2025

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