Basic Information
| Provider Information | |||||||||
| NPI: | 1265973531 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PELOT | ||||||||
| FirstName: | ABBEY | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | LMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 86 KRAGER RD | ||||||||
| Address2: | |||||||||
| City: | BINGHAMTON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 139041143 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3154360642 | ||||||||
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| Practice Location | |||||||||
| Address1: | 139 GRAND AVE | ||||||||
| Address2: | |||||||||
| City: | JOHNSON CITY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 137901675 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6072170066 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/20/2017 | ||||||||
| LastUpdateDate: | 03/20/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 094697-1 | NY | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.