Doctor Name: | MARY PETERSEN |
NPI Number: | 1003986068 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MSW, ACSW |
License Number: | 6801080062 |
Business Practice Address: | 58144 Gratiot Ave New Haven, MI - 48048 |
Business Phone Number: | 8107944982 |
Business Fax Number: | 8107944407 |
Mailing Address: | 555 Saint Clair River Dr, ALGONAC |
State: | MI |
Postal Code: | 480011802 |
Phone Number: | 8107944982 |
Fax Number: | 8107944407 |
NPI Enumeration Date: | 11/08/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | 6801080062 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MI |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |