MEDICARE: MS. RITA MARIE CHENOWETH 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	SW14453	FL

General Provider Information

NPI Number	:	1619443595
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. RITA MARIE CHENOWETH PETERSON LCSW

Provider Business Mailing Address
First Line	:	8522 CREEDMOOR LN
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34654-4620
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8522 CREEDMOOR LN
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34654-4620
Country	:	US
Telephone Number	:	727-359-7460
Fax Number	:

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

Provider Enumeration Date	:	10/18/2018
Last Update Date	:	10/18/2018

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