=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902977085
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NANCY E PETER MSW, LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/12/2006
-----------------------------------------------------
Last Update Date | 05/01/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3330 OLD GLENVIEW RD SUITE 1
-----------------------------------------------------
City | WILMETTE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60091-2963
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-212-6329
-----------------------------------------------------
Fax | 847-486-0983
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 263
-----------------------------------------------------
City | GLENVIEW
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60025-0263
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-212-6329
-----------------------------------------------------
Fax | 847-486-0983
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 149008333
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------