Sally L Pettus, SALLY PETTUS ED.D

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

MA2099 Issued in MA

Practice address

400 Faunce Corner Rd
Sheriff'S Office
North Dartmouth, MA 02747-1275

Phone

(508) 995-6400

NPI assigned

Apr 3, 2007

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Ms. Sally F Wyatt Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1175558400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1821119801",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "241 RIVER RD",
            "city": "WESTPORT",
            "state": "MA",
            "postal_code": "027905106",
            "telephone_number": "508-636-6854"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 FAUNCE CORNER RD",
            "address_2": "SHERIFF'S OFFICE",
            "city": "NORTH DARTMOUTH",
            "state": "MA",
            "postal_code": "027471275",
            "telephone_number": "508-995-6400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETTUS",
        "first_name": "SALLY",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "SALLY PETTUS ED.D",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-04-03",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MA",
            "license": "MA2099",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SALLY",
            "last_name": "WYATT",
            "middle_name": "F",
            "prefix": "MS.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Philip A Pelletier, MSN, NP-C
• Theresa E Pereira, LICSW
• Mark E Perry, M.D.
• Ryan Perry, PMHNP-BC
• Christian A Petrulio, MD
• Pharmahealth Hawthorne Inc
• Julie M Phenix, MS CCC SLP
• Matthew Frank Philips, M.D.
• Heather M Pianfetti, AUD
• James Picard

• Clinical Psychologist in North Dartmouth, MA
• Providers in North Dartmouth, MA by specialty
• Clinical Psychologist in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.