Provider Demographics
NPI:1326039041
Name:PETERSON, HATTIE ANNA (MSW, LICSW)
Entity Type:Individual
Prefix:MS
First Name:HATTIE
Middle Name:ANNA
Last Name:PETERSON
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:MRS
Other - First Name:GORDON
Other - Middle Name:
Other - Last Name:KIRSCHNER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LICSW
Mailing Address - Street 1:3421 GARRISON ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20008-2038
Mailing Address - Country:US
Mailing Address - Phone:202-966-1876
Mailing Address - Fax:202-362-2029
Practice Address - Street 1:3421 GARRISON ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20008-2038
Practice Address - Country:US
Practice Address - Phone:202-966-1876
Practice Address - Fax:202-966-1876
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-02
Last Update Date:2014-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC1326039041OtherNPI
DC490680Medicare PIN