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General NPI Number Information
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NPI Number | 1023646387
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Entity Type | Individual
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Provider Name | PETER AVERY PHD
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Gender | Male
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Dates
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Enumeration Date | 03/31/2020
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Last Update Date | 06/03/2021
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Provider Practice Location Address
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Address Line | 36 PARK ST
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City | MONTCLAIR
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State | NJ
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Zip | 07042-3440
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Country | US
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Telephone | 973-865-1297
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Fax |
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Provider Business Mailing Address
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Address Line | 36 PARK ST
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City | MONTCLAIR
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State | NJ
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Zip | 07042-3440
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Country | US
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Telephone | 973-865-1297
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 023670
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 6395
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License Number State | NJ
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