Provider Demographics
NPI:1346515723
Name:PETERSON, ANNE (LPC)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:
Last Name:PETERSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 271
Mailing Address - Street 2:
Mailing Address - City:ESSEX
Mailing Address - State:CT
Mailing Address - Zip Code:06426
Mailing Address - Country:US
Mailing Address - Phone:860-767-0444
Mailing Address - Fax:860-767-0444
Practice Address - Street 1:90 MAIN ST STE 103B
Practice Address - Street 2:
Practice Address - City:CENTERBROOK
Practice Address - State:CT
Practice Address - Zip Code:06409-1057
Practice Address - Country:US
Practice Address - Phone:860-767-0444
Practice Address - Fax:860-767-0444
Is Sole Proprietor?:No
Enumeration Date:2012-03-19
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001920101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health