MEDICARE: ERIC V PETERMAN BSW

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1417422114
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIC V PETERMAN BSW

Provider Business Mailing Address
First Line	:	10354 FOX TRAIL RD S APT 1507
Second Line	:
City	:	ROYAL PALM BEACH
State	:	FL
Zip	:	33411-1439
Country	:	US
Telephone Number	:	561-294-1223
Fax Number	:

Provider Business Practice Location Address
First Line	:	10354 FOX TRAIL RD S APT 1507
Second Line	:
City	:	ROYAL PALM BEACH
State	:	FL
Zip	:	33411-1439
Country	:	US
Telephone Number	:	561-294-1223
Fax Number	:

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

Provider Enumeration Date	:	10/09/2018
Last Update Date	:	10/09/2018

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