Provider Demographics
NPI:1326708934
Name:PANTHAUER, PETER DOLF (MFT)
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:DOLF
Last Name:PANTHAUER
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 KATONA DR STE 25A
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824-3547
Mailing Address - Country:US
Mailing Address - Phone:203-295-5273
Mailing Address - Fax:
Practice Address - Street 1:60 KATONA DR STE 25A
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824-3547
Practice Address - Country:US
Practice Address - Phone:203-295-5273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-22
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000662106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist