Provider Demographics
NPI:1497081764
Name:PETERS, NICOLE A (MA)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:A
Last Name:PETERS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:A
Other - Last Name:ROMYN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:200 N 7TH STREET
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:PA
Mailing Address - Zip Code:17046-5040
Mailing Address - Country:US
Mailing Address - Phone:717-273-1710
Mailing Address - Fax:717-273-1416
Practice Address - Street 1:1733 PENN AVE
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19609-2054
Practice Address - Country:US
Practice Address - Phone:610-670-9923
Practice Address - Fax:610-670-2587
Is Sole Proprietor?:No
Enumeration Date:2009-10-21
Last Update Date:2010-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst