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General NPI Number Information
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NPI Number | 1952402224
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Entity Type | Organization
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Legal Business Name | JULIE ANN PETERSON, P.A.
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Dates
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Enumeration Date | 09/26/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 28 WINTER ST UNIT 2
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City | NORWAY
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State | ME
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Zip | 04268-5620
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Country | US
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Telephone | 207-890-8779
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Fax | 207-739-2453
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Provider Business Mailing Address
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Address Line | PO BOX 633
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City | NORWAY
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State | ME
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Zip | 04268-0633
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Country | US
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Telephone | 207-890-8779
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Fax | 207-739-2453
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. JULIE ANN PETERSON
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Credential | LCSW
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Telephone | 207-739-2454
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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 | LC8164
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License Number State | ME
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