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General NPI Number Information
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NPI Number | 1831244110
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Entity Type | Organization
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Legal Business Name | LAURIE J PETERSON-DEERFIELD
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Dates
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Enumeration Date | 01/24/2007
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Last Update Date | 03/14/2013
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Provider Practice Location Address
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Address Line | 1000 WHITE HORSE RD., SUITE 602 GLENDALE EXECUTIVE CAMPUS
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City | VOORHEES
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State | NJ
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Zip | 08043-4501
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Country | US
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Telephone | 856-770-0021
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Fax | 856-770-9521
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Provider Business Mailing Address
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Address Line | 1000 WHITE HORSE RD. SUITE 602 GLENDALE EXECUTIVE CAMPUS
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City | VOORHEES
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State | NJ
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Zip | 08043-4501
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Country | US
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Telephone | 856-770-0021
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Fax | 856-770-9521
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Authorized Official
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Title or Position | OWNER
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Name | DR. LAURIE DEERFIELD
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Credential | D.O.
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Telephone | 856-770-0021
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 25MB07419100
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License Number State | NJ
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