Provider Demographics
NPI:1376773812
Name:PETERS, PAOLA MARIANA (LMFT)
Entity Type:Individual
Prefix:
First Name:PAOLA
Middle Name:MARIANA
Last Name:PETERS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 CLINTON LN
Mailing Address - Street 2:
Mailing Address - City:SCOTCH PLAINS
Mailing Address - State:NJ
Mailing Address - Zip Code:07076-2828
Mailing Address - Country:US
Mailing Address - Phone:908-525-6188
Mailing Address - Fax:
Practice Address - Street 1:17 CLINTON LN
Practice Address - Street 2:
Practice Address - City:SCOTCH PLAINS
Practice Address - State:NJ
Practice Address - Zip Code:07076-2828
Practice Address - Country:US
Practice Address - Phone:908-525-6188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-17
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37FI00182000106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist