Healthcare Provider Details

I. General information

NPI: 1366727794
Provider Name (Legal Business Name): STEPHEN EDWARD PETERS MSW, LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2011
Last Update Date: 09/28/2021
Certification Date: 09/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2021 BIGLERVILLE RD
GETTYSBURG PA
17325-8089
US

IV. Provider business mailing address

2021 BIGLERVILLE RD
GETTYSBURG PA
17325-8089
US

V. Phone/Fax

Practice location:
  • Phone: 570-240-1353
  • Fax:
Mailing address:
  • Phone: 570-240-1353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW018619
License Number StatePA

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: