Provider Demographics
NPI:1508035098
Name:PETERSON, JOANNA SUE (MGW, LCSW)
Entity Type:Individual
Prefix:MS
First Name:JOANNA
Middle Name:SUE
Last Name:PETERSON
Suffix:
Gender:F
Credentials:MGW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:460 SPRING ST.
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47130
Mailing Address - Country:US
Mailing Address - Phone:812-280-2080
Mailing Address - Fax:812-206-1213
Practice Address - Street 1:460 SPRING ST.
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130
Practice Address - Country:US
Practice Address - Phone:812-280-2080
Practice Address - Fax:812-206-1213
Is Sole Proprietor?:No
Enumeration Date:2008-02-28
Last Update Date:2012-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34003562A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical