Provider Demographics
NPI:1528582574
Name:PETERS, ANDI
Entity Type:Individual
Prefix:
First Name:ANDI
Middle Name:
Last Name:PETERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:829 STATE RD
Mailing Address - Street 2:
Mailing Address - City:WEST GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:19390-9528
Mailing Address - Country:US
Mailing Address - Phone:302-690-3240
Mailing Address - Fax:
Practice Address - Street 1:829 STATE RD
Practice Address - Street 2:
Practice Address - City:WEST GROVE
Practice Address - State:PA
Practice Address - Zip Code:19390-9528
Practice Address - Country:US
Practice Address - Phone:302-690-3240
Practice Address - Fax:302-690-3240
Is Sole Proprietor?:No
Enumeration Date:2017-08-01
Last Update Date:2017-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical