Provider Demographics
NPI:1497521892
Name:DENIS, PETERSON (MSW)
Entity Type:Individual
Prefix:
First Name:PETERSON
Middle Name:
Last Name:DENIS
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 WILLIAM ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07102-2840
Mailing Address - Country:US
Mailing Address - Phone:862-215-2229
Mailing Address - Fax:
Practice Address - Street 1:15 WILLIAM ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07102-2840
Practice Address - Country:US
Practice Address - Phone:862-215-2229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-28
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker