Pettis, Raymond Richard
Pettis, Raymond Richard is an individual health care provider with primary practice located at 31 Thurber Dr , Waterloo NY 13165-1600. He recently has only one registered license in Behavioral Health & Social Service Providers / Mental Health, which is considered as his primary health care specialty. Pettis, Raymond Richard can be contacted via phone (315) 539-1980.Contact Information
Primary practice address
31 Thurber Dr
Waterloo NY 13165-1600
Phone: (315) 539-1980
Fax: (315) 539-1054
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Mental Health | 101YM0800X | 001185 | New York |
Profile Details
| NPI number | 1073620753 |
|---|---|
| LBN Legal business name | Pettis, Raymond Richard |
| Credentials | MS, LMHC |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Aug 25th, 2006 |
| Last updated | Jul 8th, 2007 - about 17 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1073620753 | NPPES |
| New York | MEDICAID | 001185 |
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