MEDICARE: ROSE PENDALA ANDREJCZYK PSY.D

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	103T00000X	Psychologist

General Provider Information

NPI Number	:	1760636385
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROSE PENDALA ANDREJCZYK PSY.D

Provider Business Mailing Address
First Line	:	20 NEW LUDLOW RD
Second Line	:
City	:	SOUTH HADLEY
State	:	MA
Zip	:	01075-3002
Country	:	US
Telephone Number	:	413-536-1958
Fax Number	:

Provider Business Practice Location Address
First Line	:	20 NEW LUDLOW RD
Second Line	:
City	:	SOUTH HADLEY
State	:	MA
Zip	:	01075-3002
Country	:	US
Telephone Number	:	413-536-1958
Fax Number	:

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

Provider Enumeration Date	:	11/10/2008
Last Update Date	:	11/10/2008

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