MEDICARE: ROGER L PETERSON PHD

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	103T00000X	Psychologist	LP286	NH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316916554
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROGER L PETERSON PHD

Provider Business Mailing Address
First Line	:	1 PHOENIX MILL LN
Second Line	:	STE 200
City	:	PETERBOROUGH
State	:	NH
Zip	:	03458-1476
Country	:	US
Telephone Number	:	603-924-7797
Fax Number	:	603-822-2813

Provider Business Practice Location Address
First Line	:	222 WEST ST STE 29B
Second Line	:
City	:	KEENE
State	:	NH
Zip	:	03431-2458
Country	:	US
Telephone Number	:	603-903-3373
Fax Number	:	603-357-1185

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/17/2006
Last Update Date	:	04/21/2016

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