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General NPI Number Information
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NPI Number | 1437911237
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Entity Type | Individual
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Provider Name | GRACE HARRIS PETERSON
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Gender | Female
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Dates
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Enumeration Date | 01/26/2024
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Last Update Date | 01/26/2024
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Provider Practice Location Address
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Address Line | 132 OLD RIVER RD STE 100
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City | LINCOLN
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State | RI
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Zip | 02865-1158
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Country | US
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Telephone | 781-327-0827
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Fax |
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Provider Business Mailing Address
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Address Line | 43 L ST UNIT 2
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City | BOSTON
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State | MA
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Zip | 02127-1662
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Country | US
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Telephone | 617-694-3831
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 229252
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License Number State | MA
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