Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | 0003576-1 | NY |
NPI | 1033449798 |
---|---|
Provider Name | Dr. Peter Dorian Ladd |
First Address | Clayton, NY 13624-0184 |
Second Address | Clayton, NY 13624-0184 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/12/2009 |
Last Update Date | 31/12/2009 |