MEDICARE: MRS. MIZUKI OGAWA-PETERSON LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	44SC05303600	NJ

General Provider Information

NPI Number	:	1538381280
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MIZUKI OGAWA-PETERSON LCSW

Provider Business Mailing Address
First Line	:	38 STARKIN RD
Second Line	:
City	:	EDISON
State	:	NJ
Zip	:	08837-2849
Country	:	US
Telephone Number	:	732-881-3137
Fax Number	:

Provider Business Practice Location Address
First Line	:	15 W PROSPECT ST
Second Line	:
City	:	EAST BRUNSWICK
State	:	NJ
Zip	:	08816-2161
Country	:	US
Telephone Number	:	732-254-0600
Fax Number	:	732-254-8606

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/03/2007
Last Update Date	:	06/01/2009

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