Healthcare Provider Details

I. General information

NPI: 1487147252
Provider Name (Legal Business Name): PATRICIA MATEUS PETERSON LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2018
Last Update Date: 06/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1561 N MAIN STREET
FALL RIVER MA
02720
US

IV. Provider business mailing address

1561 N. MAIN STREET
FALL RIVER MA
02720
US

V. Phone/Fax

Practice location:
  • Phone: 508-235-9877
  • Fax: 508-672-5404
Mailing address:
  • Phone: 508-235-9877
  • Fax: 508-672-5404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number114608
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: