Healthcare Provider Details

I. General information

NPI: 1053480889
Provider Name (Legal Business Name): PETER HAM LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

466 COUNTY ST
NEW BEDFORD MA
02740-5107
US

IV. Provider business mailing address

42 WINDCHIME DR
MANSFIELD MA
02048-2934
US

V. Phone/Fax

Practice location:
  • Phone: 508-997-0794
  • Fax: 508-999-6607
Mailing address:
  • Phone: 508-337-8687
  • Fax: 508-999-6607

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1287
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: