| Doctor Name: | JEAN B. PETERSON |
| NPI Number: | 1295804193 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LCSW |
| License Number: | R010111-1 |
| Business Practice Address: | 22 Bayview Ave Stonington, CT - 063781142 |
| Business Phone Number: | 8605364478 |
| Business Fax Number: | 8605364478 |
| Mailing Address: | 6 Godfrey St, MYSTIC |
| State: | CT |
| Postal Code: | 063551702 |
| Phone Number: | 8605364478 |
| Fax Number: | 8605364478 |
| NPI Enumeration Date: | 11/06/2006 |
| NPI Last Update Date: | 01/25/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | R010111-1 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NY |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |