Provider Demographics
NPI:1598800583
Name:PETERS, JANICE M (PHD)
Entity Type:Individual
Prefix:DR
First Name:JANICE
Middle Name:M
Last Name:PETERS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:227 HAMBURG TPKE
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:POMPTON LAKES
Mailing Address - State:NJ
Mailing Address - Zip Code:07442-1847
Mailing Address - Country:US
Mailing Address - Phone:973-981-8599
Mailing Address - Fax:973-907-7734
Practice Address - Street 1:227 HAMBURG TPKE
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:POMPTON LAKES
Practice Address - State:NJ
Practice Address - Zip Code:07442-1847
Practice Address - Country:US
Practice Address - Phone:973-981-8599
Practice Address - Fax:973-907-7734
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ4371103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist