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General NPI Number Information
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NPI Number | 1710043211
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Entity Type | Individual
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Provider Name | J. PETERSON PH.D., L.L.C.
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Gender | Female
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Dates
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Enumeration Date | 12/29/2006
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Last Update Date | 02/27/2008
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Provider Practice Location Address
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Address Line | 129 EAST GERMAN STREET ROOM 210
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City | SHEPHERDSTOWN
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State | WV
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Zip | 25443-1650
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Country | US
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Telephone | 304-876-3766
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Fax | 304-876-8431
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Provider Business Mailing Address
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Address Line | PO BOX 1650
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City | SHEPHERDSTOWN
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State | WV
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Zip | 25443-1650
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Country | US
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Telephone | 304-876-3766
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Fax | 304-876-8431
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 741
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License Number State | WV
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