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General NPI Number Information
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NPI Number | 1376421586
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Entity Type | Individual
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Provider Name | JOSEPH PATRICK PETERSON PHD, JD
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Gender | Male
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Dates
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Enumeration Date | 08/25/2025
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Last Update Date | 08/25/2025
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Provider Practice Location Address
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Address Line | 4441 KIMBERLY CIR
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City | TALLAHASSEE
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State | FL
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Zip | 32309-9624
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Country | US
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Telephone | 850-597-2425
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 11064
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City | TALLAHASSEE
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State | FL
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Zip | 32302-3064
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Country | US
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Telephone | 850-597-2425
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Fax | 850-671-3230
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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 | PY0003363
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License Number State | FL
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