MEDICARE: ANTOINETTE PETERSON,LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	6801061284	MI

General Provider Information

NPI Number	:	1194050914
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANTOINETTE PETERSON,LLC

Provider Business Mailing Address
First Line	:	147 N MILFORD RD STE 201
Second Line	:
City	:	HIGHLAND
State	:	MI
Zip	:	48357-4500
Country	:	US
Telephone Number	:	248-563-0587
Fax Number	:

Provider Business Practice Location Address
First Line	:	147 N MILFORD RD
Second Line	:	SUITE 201A
City	:	HIGHLAND
State	:	MI
Zip	:	48357-4500
Country	:	US
Telephone Number	:	248-563-0587
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ANTOINETTE PETERSON
Credential	:	LMSW
Telephone Number	:	248-563-0587

Provider Enumeration Date	:	10/13/2009
Last Update Date	:	10/06/2023

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