Healthcare Provider Details

I. General information

NPI: 1013133503
Provider Name (Legal Business Name): ERIC J. PETERS PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 ADDISON CIR
SUFFIELD CT
06078-1464
US

IV. Provider business mailing address

1 ADDISON CIR
SUFFIELD CT
06078-1464
US

V. Phone/Fax

Practice location:
  • Phone: 413-418-7691
  • Fax:
Mailing address:
  • Phone: 413-418-7691
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number9179
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: