Provider Demographics
NPI:1215552799
Name:PETERS, ROBERT JOSEPH (LCSW)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:JOSEPH
Last Name:PETERS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13226 W LEGION HALL RD
Mailing Address - Street 2:
Mailing Address - City:PRINCEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:61559-9151
Mailing Address - Country:US
Mailing Address - Phone:309-645-7601
Mailing Address - Fax:
Practice Address - Street 1:13226 W LEGION HALL RD
Practice Address - Street 2:
Practice Address - City:PRINCEVILLE
Practice Address - State:IL
Practice Address - Zip Code:61559-9151
Practice Address - Country:US
Practice Address - Phone:309-645-7601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-10
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0183061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL149.018306OtherSTATE LCSW NUMBER