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Nickolas Petragallo, CRM/PSS
Peer Specialist in Bend, Oregon
NPI 1740887561

Nickolas Petragallo is a Peer Specialist based in Bend, OR. Nickolas Petragallo practices in Bend, OR and has the professional credentials of CRM/PSS. The NPI Number for Nickolas Petragallo is 1740887561 and holds a License No. 20-CRM-242 (Oregon).

The current practice location address for Nickolas Petragallo is 908 Ne 4Th St Ste 101, Bend, OR and can be reached out via phone at 541-617-7365.

Location: 908 Ne 4Th St Ste 101, Bend, OR, 97701-4646
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1740887561
Provider Name
Nickolas Petragallo
Credential
CRM/PSS
Provider Entity Type
Individual
Gender
Male
Address
908 Ne 4Th St Ste 101, Bend, OR, 97701-4646
Phone Number
541-617-7365
Fax Number
Provider Enumeration Date
10/05/2020
Last Update Date
03/10/2024
institution
Provider Business Practice Location Address Details
Address
908 Ne 4Th St Ste 101
City
Bend
State
Oregon
Zip
97701-4646
Phone Number
541-617-7365
Fax Number
person
Provider Business Mailing Address Details
Address
908 Ne 4Th St Ste 101
City
Bend
State
Oregon
Zip
97701-4646
Phone Number
541-617-7365
Fax Number
person
Provider's Taxonomy Details 1
Type
Other Service Providers
Classification
Peer Specialist
Speciality
-
Taxonomy
175T00000X
License No.
20-CRM-242 (Oregon)
Definition
Individuals certified to perform peer support services through a training process defined by a government agency, such as the Department of Veterans Affairs or a state mental health department/certification/licensing authority.
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