Provider Demographics
NPI:1043301286
Name:CHERCHIA, PETER J (PHD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:J
Last Name:CHERCHIA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:89 MAIN STREET - SUITE 407
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01757-2628
Mailing Address - Country:US
Mailing Address - Phone:508-473-4984
Mailing Address - Fax:508-482-7316
Practice Address - Street 1:89 MAIN STREET - SUITE 407
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:MA
Practice Address - Zip Code:01757-2628
Practice Address - Country:US
Practice Address - Phone:508-473-4984
Practice Address - Fax:508-482-7316
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1771103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW0221301Medicaid
MAW02213Medicare ID - Type Unspecified