Provider Demographics
NPI:1558499665
Name:WAFUL, PETER J (MSW LICSW DCSW)
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:J
Last Name:WAFUL
Suffix:
Gender:M
Credentials:MSW LICSW DCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1065 MILLSTONE RD
Mailing Address - Street 2:
Mailing Address - City:BREWSTER
Mailing Address - State:MA
Mailing Address - Zip Code:02631-2615
Mailing Address - Country:US
Mailing Address - Phone:508-896-5890
Mailing Address - Fax:508-896-6594
Practice Address - Street 1:1065 MILLSTONE RD
Practice Address - Street 2:
Practice Address - City:BREWSTER
Practice Address - State:MA
Practice Address - Zip Code:02631-2615
Practice Address - Country:US
Practice Address - Phone:508-896-5890
Practice Address - Fax:508-896-6594
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10194101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
P05535Medicare ID - Type Unspecified
R42445Medicare UPIN