Provider Demographics
NPI:1043245137
Name:PETERSON, JUNE W (LCSW C)
Entity Type:Individual
Prefix:MRS
First Name:JUNE
Middle Name:W
Last Name:PETERSON
Suffix:
Gender:F
Credentials:LCSW C
Other - Prefix:
Other - First Name:JUNE
Other - Middle Name:LEE
Other - Last Name:PETERSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6310 HARFORD RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21214-1315
Mailing Address - Country:US
Mailing Address - Phone:410-426-6370
Mailing Address - Fax:410-426-3491
Practice Address - Street 1:6310 HARFORD RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21214-1315
Practice Address - Country:US
Practice Address - Phone:410-426-6370
Practice Address - Fax:410-426-3491
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD4861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
269RMedicare ID - Type Unspecified