Provider Demographics
NPI:1437294923
Name:PETERSON, ROBERT SCHAEFER (MED)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:SCHAEFER
Last Name:PETERSON
Suffix:
Gender:M
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:865 HILLTOP ROAD
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16509-2153
Mailing Address - Country:US
Mailing Address - Phone:814-868-2178
Mailing Address - Fax:
Practice Address - Street 1:865 HILLTOP ROAD
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16509-2153
Practice Address - Country:US
Practice Address - Phone:814-868-2178
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS003737L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01846910OtherDEPT PUBLIC WELFARE