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General NPI Number Information
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NPI Number | 1073634705
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Entity Type | Individual
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Provider Name | DEBRA SUSAN PETERSEN B.S.ED.
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Gender | Female
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Dates
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Enumeration Date | 04/02/2007
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 500 7TH AVE S DEPT. 7470
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City | ST PETERSBURG
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State | FL
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Zip | 33701-4820
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Country | US
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Telephone | 727-767-4403
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Fax | 727-767-4715
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Provider Business Mailing Address
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Address Line | 2133 42ND AVE N
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City | ST PETERSBURG
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State | FL
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Zip | 33714-4128
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Country | US
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Telephone | 727-488-6465
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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