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General NPI Number Information
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NPI Number | 1205599271
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Entity Type | Organization
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Legal Business Name | PETERSON PSYCHOTHERAPY
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Dates
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Enumeration Date | 10/18/2021
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Last Update Date | 04/05/2023
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Provider Practice Location Address
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Address Line | 3537 BEACH DR SE
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City | SAINT PETERSBURG
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State | FL
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Zip | 33705-4101
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Country | US
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Telephone | 203-260-6646
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 35205
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City | SAINT PETERSBURG
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State | FL
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Zip | 33705-0504
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Country | US
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Telephone | 786-417-1418
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Fax |
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Authorized Official
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Title or Position | THERAPIST
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Name | MS. HALEY PETERSON
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Credential | LCSW
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Telephone | 203-260-6646
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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