Healthcare Provider Details

I. General information

NPI: 1245338524
Provider Name (Legal Business Name): PETER K STIMPSON M.S.W., M.TH.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 STOCKTON ST
PRINCETON NJ
08540-6813
US

IV. Provider business mailing address

22 STOCKTON ST
PRINCETON NJ
08540-6813
US

V. Phone/Fax

Practice location:
  • Phone: 609-924-0060
  • Fax: 609-924-7436
Mailing address:
  • Phone: 609-924-0060
  • Fax: 609-924-7436

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC00179400
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberPR020016-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: