Healthcare Provider Details

I. General information

NPI: 1689676207
Provider Name (Legal Business Name): LAURIE J DEERFIELD DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LAURIE J PETERSON-DEERFIELD DO

II. Dates (important events)

Enumeration Date: 08/12/2005
Last Update Date: 08/08/2025
Certification Date: 08/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

241 RIVERSIDE DR UNIT 1907
HOLLY HILL FL
32117
US

IV. Provider business mailing address

241 RIVERSIDE DR UNIT 1907
HOLLY HILL FL
32117
US

V. Phone/Fax

Practice location:
  • Phone: 856-397-3970
  • Fax: 856-397-3970
Mailing address:
  • Phone: 856-397-3970
  • Fax: 856-397-3970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberOS8079
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberDO3156
License Number StateME
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number25MB07419
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: