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NPI Code Detail

MEDICARE: MR. NATHAN Y PETERSON L.M.H.C.

MEDICARE: MR. NATHAN Y PETERSON L.M.H.C.
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
1101YP2500XProfessional Counselor4378MA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MA4378OTHERMABCBSMA

General Provider Information

NPI Number : 1528134848
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. NATHAN Y PETERSON L.M.H.C.
Provider Business Mailing Address
First Line : 59 WHITINS RD
Second Line :
City : SUTTON
State : MA
Zip : 01590-2728
Country : US
Telephone Number : 508-770-0511
Fax Number : 508-770-0875
Provider Business Practice Location Address
First Line : 172 LINCOLN ST
Second Line :
City : WORCESTER
State : MA
Zip : 01605-3750
Country : US
Telephone Number : 508-770-0511
Fax Number : 508-770-0875
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/28/2006
Last Update Date : 07/08/2007

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