Provider Demographics
NPI:1730547597
Name:PEAK PEDIATRIC PSYCHOLOGY LLC
Entity type:Organization
Organization Name:PEAK PEDIATRIC PSYCHOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DORIANN
Authorized Official - Middle Name:
Authorized Official - Last Name:ADRAGNA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, EDS
Authorized Official - Phone:970-497-4921
Mailing Address - Street 1:1550 E. NIAGARA ROAD
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CO
Mailing Address - Zip Code:81401-5027
Mailing Address - Country:US
Mailing Address - Phone:970-497-4921
Mailing Address - Fax:970-701-4161
Practice Address - Street 1:1550 E. NIAGARA ROAD
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CO
Practice Address - Zip Code:81401
Practice Address - Country:US
Practice Address - Phone:970-497-4921
Practice Address - Fax:970-701-4161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-08
Last Update Date:2016-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchoolGroup - Single Specialty