| Doctor Name: | MARJORIE PETERSON |
| NPI Number: | 1861568503 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LCSW |
| License Number: | 03248672006051 |
| Business Practice Address: | 6 Tods Driftway Old Greenwich, CT - 068702412 |
| Business Phone Number: | 2032571411 |
| Business Fax Number: | 2032571411 |
| Mailing Address: | 6 Tods Driftway, OLD GREENWICH |
| State: | CT |
| Postal Code: | 068702412 |
| Phone Number: | 2032571411 |
| Fax Number: | 2032571411 |
| NPI Enumeration Date: | 11/27/2006 |
| NPI Last Update Date: | 06/06/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 03248672006051 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CT |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |