Provider Demographics
NPI:1083871925
Name:WHITMER, PETER OWEN (PHD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:OWEN
Last Name:WHITMER
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 1:10 LAUREL LN
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:MA
Mailing Address - Zip Code:01541-1018
Mailing Address - Country:US
Mailing Address - Phone:978-464-5019
Mailing Address - Fax:978-464-5019
Practice Address - Street 1:10 LAUREL LN
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:MA
Practice Address - Zip Code:01541-1018
Practice Address - Country:US
Practice Address - Phone:978-464-5019
Practice Address - Fax:978-464-5019
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-19
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2936103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical