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General NPI Number Information
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NPI Number | 1306215462
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Entity Type | Organization
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Legal Business Name | ANNE PETERSON LLC
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Dates
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Enumeration Date | 09/18/2015
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Last Update Date | 09/18/2015
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Provider Practice Location Address
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Address Line | 80 PLAINS RD
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City | ESSEX
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State | CT
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Zip | 06426
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Country | US
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Telephone | 860-767-0444
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Fax | 860-767-0444
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Provider Business Mailing Address
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Address Line | PO BOX 271
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City | ESSEX
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State | CT
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Zip | 06426-0271
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Country | US
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Telephone | 860-767-0444
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Fax | 860-767-0444
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Authorized Official
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Title or Position | OWNER/CLINICIAN
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Name | ANNE PETERSON
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Credential | LPC
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Telephone | 860-767-0444
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State | CT
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