Healthcare Provider Details

I. General information

NPI: 1396226163
Provider Name (Legal Business Name): AILEEN PETERS MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2018
Last Update Date: 06/27/2026
Certification Date: 06/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

645R MASS AVE
ARLINGTON MA
02476-5004
US

IV. Provider business mailing address

6 STONE POST RD
ANDOVER MA
01810-2237
US

V. Phone/Fax

Practice location:
  • Phone: 617-977-4741
  • Fax:
Mailing address:
  • Phone: 978-852-7197
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY5000387
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: