Provider Demographics
NPI:1568643732
Name:PETKOV, BARBARA (EDS)
Entity Type:Individual
Prefix:MRS
First Name:BARBARA
Middle Name:
Last Name:PETKOV
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:328 DENISON ST
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08904-2732
Mailing Address - Country:US
Mailing Address - Phone:732-565-9010
Mailing Address - Fax:732-565-0703
Practice Address - Street 1:328 DENISON ST
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:08904-2732
Practice Address - Country:US
Practice Address - Phone:732-565-9010
Practice Address - Fax:732-565-0703
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-16
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist