Provider Demographics
NPI:1245738103
Name:PETERSEL, MARTIN A (LMFT, LMHC)
Entity Type:Individual
Prefix:MR
First Name:MARTIN
Middle Name:A
Last Name:PETERSEL
Suffix:
Gender:M
Credentials:LMFT, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 REXAL COURT
Mailing Address - Street 2:
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956
Mailing Address - Country:US
Mailing Address - Phone:845-499-2482
Mailing Address - Fax:
Practice Address - Street 1:3 REXAL COURT
Practice Address - Street 2:
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956
Practice Address - Country:US
Practice Address - Phone:845-499-2482
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001567-1101YM0800X
NY000322-1106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health