Provider Demographics
NPI:1003919051
Name:LOIACONO, PETER
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:LOIACONO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 541
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTERFIELD
Mailing Address - State:NH
Mailing Address - Zip Code:03466-0541
Mailing Address - Country:US
Mailing Address - Phone:802-257-7785
Mailing Address - Fax:
Practice Address - Street 1:25 ROXBURY ST
Practice Address - Street 2:
Practice Address - City:KEENE
Practice Address - State:NH
Practice Address - Zip Code:03431-3257
Practice Address - Country:US
Practice Address - Phone:603-499-1775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT000151101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT000151OtherVERMONT ALCOHOL AND DRUG COUNSELOR CERTIFICATION BOARD
NH0588OtherNEW HAMPSHIRE BOARD OF ALCOHOL &OTHER DRUG ABUSE PROFESSIONAL PRACTICE
MA2221OtherMASSACHUSETTS BUREAU OF SUBSTANCE ABUSE SERVICES